Diabetes has been associated with an increased risk of hepatocellular carcinoma in studies of referred patients.
This is the first population based case control study in America to examine this association while adjusting for other major risk factors related to hepatocellular carcinoma.
Dr El-Serag and colleagues from Texas, America used the Surveillance Epidemiology and End-Results Program Medicare linked database to identify patients aged 65 years and older diagnosed with hepatocellular carcinoma.
The research team randomly selected non-cancer controls between 1994 and 1999.
The team examined only cases and controls with continuous Medicare enrolment for 3 years prior to the index date.
Inpatient and outpatient claims files were searched by the investigators for diagnostic codes indicative of diabetes, Hepatitis C virus, Hepatitis B virus, alcoholic liver disease, and haemochromatosis.
Patients with hepatocellular carcinoma without these conditions were categorized as idiopathic.
Unadjusted and adjusted odds ratios were calculated in logistic regression analyses.
|A significant positive interaction was found between Hepatitis C and diabetes|
The investigators identified 2,061 patients with hepatocellular carcinoma and 6,183 non-cancer controls.
Compared with non-cancer controls, patients with hepatocellular carcinoma were male (66% versus 36%) and non-White (34% versus 18%).
The investigative team noted that the proportion of patients with hepatocellular carcinoma with diabetes (43%) was significantly greater than non-cancer controls (19%).
Multiple logistic regression analyses was used by the researchers to adjust for demographics features and other hepatocellular carcinoma risk factors (Hepatitis C virus, Hepatitis B virus, alcoholic liver disease, and haemochromatosis).
The team showed that diabetes was associated with a threefold increase in the risk of hepatocellular carcinoma.
In a subset of patients without these major risk factors, the adjusted odds ratio for diabetes declined but remained significant.
The investigators detected a significant positive interaction between Hepatitis C virus and diabetes.
In addition, the research team reported similar findings that persisted in analyses restricted to diabetes between 2 and 3 years prior to hepatocellular carcinoma diagnosis.
Dr El-Serag concluded, “Diabetes is associated with a 2 to 3 fold increase in the risk of hepatocellular carcinoma, regardless of the presence of other major hepatocellular carcinoma risk factors.
"Findings from this population based study suggest that diabetes is an independent risk factor for hepatocellular carcinoma."