Diabetes Mellitus Heightens the Risk of Hepatocellular Carcinoma Except in Patients With Hepatitis C Cirrhosis

Ju Dong Yang, Hager Amed Mohamed, Jessica L. Cvinar, Gregory James Gores, Lewis Rowland Roberts, W. Ray Kim

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVES:As most hepatocellular carcinoma (HCC) patients have cirrhosis, the association between diabetes and HCC may be confounded by the fact that diabetes is common in patients with cirrhosis. The aim of this study is to investigate whether diabetes increases the risk of HCC in patients with cirrhosis and whether the etiology of liver disease modifies the association between diabetes and HCC.METHODS:All liver cirrhosis patients who had repeated radiographic evaluation of the liver (that is, ultrasound, computed tomography, or magnetic resonance image) at Mayo Clinic Rochester between January 2006 and December 2011 were included. The Cox proportional hazard regression analysis was used to investigate the effect of diabetes on the risk of HCC.RESULTS:A total of 739 patients met the eligibility criteria, of whom 253 (34%) had diabetes. After a median follow-up of 38 months, 69 (9%) patients developed HCC. In patients without hepatitis C virus (HCV) infection, diabetes was significantly associated with the risk of developing HCC (hazard ratio (HR)=2.1, 95% confidence interval (CI)=1.1–4.1), whereas in patients with HCV, there was no association (HR=0.8, 95% CI=0.4–1.8). When adjusted for covariates, the interaction between HCV and diabetes remained significant (HR for non-HCV=1.9, 95% CI=0.9–3.7; HR for HCV=0.6, 95% CI=0.2–1.3). Lack of association between diabetes and HCC was externally validated in 410 patients with HCV cirrhosis enrolled in the HALT-C trial.CONCLUSIONS:Diabetes increases the risk of HCC in patients with non-HCV cirrhosis. In HCV cirrhosis patients who already have very high risk, diabetes may not increase the risk any further.Am J Gastroenterol advance online publication, 16 August 2016; doi:10.1038/ajg.2016.330.

Original languageEnglish (US)
JournalAmerican Journal of Gastroenterology
DOIs
StateAccepted/In press - Aug 16 2016

Fingerprint

Hepatitis C
Hepatocellular Carcinoma
Diabetes Mellitus
Fibrosis
Hepacivirus
Confidence Intervals
Viruses
Virus Diseases
Liver Cirrhosis
Publications
Liver Diseases
Magnetic Resonance Spectroscopy
Tomography
Regression Analysis

ASJC Scopus subject areas

  • Medicine(all)
  • Gastroenterology

Cite this

Diabetes Mellitus Heightens the Risk of Hepatocellular Carcinoma Except in Patients With Hepatitis C Cirrhosis. / Yang, Ju Dong; Mohamed, Hager Amed; Cvinar, Jessica L.; Gores, Gregory James; Roberts, Lewis Rowland; Kim, W. Ray.

In: American Journal of Gastroenterology, 16.08.2016.

Research output: Contribution to journalArticle

@article{bc42965e12b84418ab22955f86e59ff9,
title = "Diabetes Mellitus Heightens the Risk of Hepatocellular Carcinoma Except in Patients With Hepatitis C Cirrhosis",
abstract = "OBJECTIVES:As most hepatocellular carcinoma (HCC) patients have cirrhosis, the association between diabetes and HCC may be confounded by the fact that diabetes is common in patients with cirrhosis. The aim of this study is to investigate whether diabetes increases the risk of HCC in patients with cirrhosis and whether the etiology of liver disease modifies the association between diabetes and HCC.METHODS:All liver cirrhosis patients who had repeated radiographic evaluation of the liver (that is, ultrasound, computed tomography, or magnetic resonance image) at Mayo Clinic Rochester between January 2006 and December 2011 were included. The Cox proportional hazard regression analysis was used to investigate the effect of diabetes on the risk of HCC.RESULTS:A total of 739 patients met the eligibility criteria, of whom 253 (34{\%}) had diabetes. After a median follow-up of 38 months, 69 (9{\%}) patients developed HCC. In patients without hepatitis C virus (HCV) infection, diabetes was significantly associated with the risk of developing HCC (hazard ratio (HR)=2.1, 95{\%} confidence interval (CI)=1.1–4.1), whereas in patients with HCV, there was no association (HR=0.8, 95{\%} CI=0.4–1.8). When adjusted for covariates, the interaction between HCV and diabetes remained significant (HR for non-HCV=1.9, 95{\%} CI=0.9–3.7; HR for HCV=0.6, 95{\%} CI=0.2–1.3). Lack of association between diabetes and HCC was externally validated in 410 patients with HCV cirrhosis enrolled in the HALT-C trial.CONCLUSIONS:Diabetes increases the risk of HCC in patients with non-HCV cirrhosis. In HCV cirrhosis patients who already have very high risk, diabetes may not increase the risk any further.Am J Gastroenterol advance online publication, 16 August 2016; doi:10.1038/ajg.2016.330.",
author = "Yang, {Ju Dong} and Mohamed, {Hager Amed} and Cvinar, {Jessica L.} and Gores, {Gregory James} and Roberts, {Lewis Rowland} and Kim, {W. Ray}",
year = "2016",
month = "8",
day = "16",
doi = "10.1038/ajg.2016.330",
language = "English (US)",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",

}

TY - JOUR

T1 - Diabetes Mellitus Heightens the Risk of Hepatocellular Carcinoma Except in Patients With Hepatitis C Cirrhosis

AU - Yang, Ju Dong

AU - Mohamed, Hager Amed

AU - Cvinar, Jessica L.

AU - Gores, Gregory James

AU - Roberts, Lewis Rowland

AU - Kim, W. Ray

PY - 2016/8/16

Y1 - 2016/8/16

N2 - OBJECTIVES:As most hepatocellular carcinoma (HCC) patients have cirrhosis, the association between diabetes and HCC may be confounded by the fact that diabetes is common in patients with cirrhosis. The aim of this study is to investigate whether diabetes increases the risk of HCC in patients with cirrhosis and whether the etiology of liver disease modifies the association between diabetes and HCC.METHODS:All liver cirrhosis patients who had repeated radiographic evaluation of the liver (that is, ultrasound, computed tomography, or magnetic resonance image) at Mayo Clinic Rochester between January 2006 and December 2011 were included. The Cox proportional hazard regression analysis was used to investigate the effect of diabetes on the risk of HCC.RESULTS:A total of 739 patients met the eligibility criteria, of whom 253 (34%) had diabetes. After a median follow-up of 38 months, 69 (9%) patients developed HCC. In patients without hepatitis C virus (HCV) infection, diabetes was significantly associated with the risk of developing HCC (hazard ratio (HR)=2.1, 95% confidence interval (CI)=1.1–4.1), whereas in patients with HCV, there was no association (HR=0.8, 95% CI=0.4–1.8). When adjusted for covariates, the interaction between HCV and diabetes remained significant (HR for non-HCV=1.9, 95% CI=0.9–3.7; HR for HCV=0.6, 95% CI=0.2–1.3). Lack of association between diabetes and HCC was externally validated in 410 patients with HCV cirrhosis enrolled in the HALT-C trial.CONCLUSIONS:Diabetes increases the risk of HCC in patients with non-HCV cirrhosis. In HCV cirrhosis patients who already have very high risk, diabetes may not increase the risk any further.Am J Gastroenterol advance online publication, 16 August 2016; doi:10.1038/ajg.2016.330.

AB - OBJECTIVES:As most hepatocellular carcinoma (HCC) patients have cirrhosis, the association between diabetes and HCC may be confounded by the fact that diabetes is common in patients with cirrhosis. The aim of this study is to investigate whether diabetes increases the risk of HCC in patients with cirrhosis and whether the etiology of liver disease modifies the association between diabetes and HCC.METHODS:All liver cirrhosis patients who had repeated radiographic evaluation of the liver (that is, ultrasound, computed tomography, or magnetic resonance image) at Mayo Clinic Rochester between January 2006 and December 2011 were included. The Cox proportional hazard regression analysis was used to investigate the effect of diabetes on the risk of HCC.RESULTS:A total of 739 patients met the eligibility criteria, of whom 253 (34%) had diabetes. After a median follow-up of 38 months, 69 (9%) patients developed HCC. In patients without hepatitis C virus (HCV) infection, diabetes was significantly associated with the risk of developing HCC (hazard ratio (HR)=2.1, 95% confidence interval (CI)=1.1–4.1), whereas in patients with HCV, there was no association (HR=0.8, 95% CI=0.4–1.8). When adjusted for covariates, the interaction between HCV and diabetes remained significant (HR for non-HCV=1.9, 95% CI=0.9–3.7; HR for HCV=0.6, 95% CI=0.2–1.3). Lack of association between diabetes and HCC was externally validated in 410 patients with HCV cirrhosis enrolled in the HALT-C trial.CONCLUSIONS:Diabetes increases the risk of HCC in patients with non-HCV cirrhosis. In HCV cirrhosis patients who already have very high risk, diabetes may not increase the risk any further.Am J Gastroenterol advance online publication, 16 August 2016; doi:10.1038/ajg.2016.330.

UR - http://www.scopus.com/inward/record.url?scp=84982162422&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84982162422&partnerID=8YFLogxK

U2 - 10.1038/ajg.2016.330

DO - 10.1038/ajg.2016.330

M3 - Article

C2 - 27527741

AN - SCOPUS:84982162422

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

ER -