Diabetes pattern on the 75 g oral glucose tolerance test is a risk factor for hepatocellular carcinoma in patients with hepatitis C virus
ABSTRACT Patients with hepatitis C virus (HCV) frequently show glucose intolerance. Diabetes mellitus (DM) has been proposed to be a risk factor for hepatocellular carcinoma (HCC).
The aim of this study is to clarify the influence of glucose intolerance as evaluated by the 75 g oral glucose tolerance test (OGTT) on hepatocarcinogenesis in patients with HCV.
This study was carried out in a cohort of 197 patients with HCV who had not been previously diagnosed as having DM. All patients underwent the 75 g OGTT at entry. They were also screened for HCC and, thereafter, the rate of hepatocarcinogenesis was compared between the patients with and without glucose intolerance.
Based on the results of the 75 g OGTT, 125 (63%) had normal glucose tolerance (NGT), 49 (25%) had impaired glucose tolerance (IGT) and 23 (12%) had the DM pattern. HCC occurred more frequently in patients with the DM pattern than in patients with either NGT or IGT. Even in patients without advanced liver fibrosis, HCC was more frequently observed in patients with DM than in patients with NGT. A multiple logistic regression analysis showed advanced liver fibrosis, the DM pattern on the 75 g OGTT, an older age and gamma-glutamyltransferase to all be independent risk factors related to hepatocarcinogenesis.
A DM pattern on the 75 g OGTT was thus found to be associated with hepatocarcinogenesis and the 75 g OGTT is considered to be useful for identifying this risk factor for HCC in patients with HCV.
SourceAvailable from: Satoshi Oeda
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ABSTRACT: Objective: The potential associations of diabetes mellitus with malignant neoplasms including liver cancer have become a great concern from both clinical and preventive perspectives. Although sufficient evidence for a positive association between diabetes and liver cancer already exists, it would be informative to summarize up-to-date epidemiologic data in Japan. Methods: We systematically reviewed epidemiologic studies on diabetes and liver cancer among Japanese populations. Original data were obtained by searching the MEDLINE (PubMed) and Ichushi databases, complemented with manual searches. The evaluation was performed in terms of the magnitude of association in each study and the strength of evidence ('convincing', 'probable', 'possible' or 'insufficient'), together with biological plausibility. Results: We identified 19 cohort studies, one pooled-analysis of seven cohort studies, and seven case-control studies. Of 24 relative risk estimates of liver cancer for diabetes reported in those cohort studies, 17 showed a weak to strong positive association, six revealed no association and one demonstrated a weak inverse association (summary relative risk 2.10, 95% confidence interval 1.60-2.76). Ten relative risk estimates from the case-control studies showed a weak to strong positive association (n = 9) or no association (n = 1; summary relative risk 2.32, confidence interval 1.73-3.12). Overall, the summary relative risk became 2.18 (confidence interval 1.78-2.69). Heterogeneity in relative risks was significant for the difference in categories of study population (P = 0.01), but not in study type (P = 0.39) or sex (P = 0.33). Conclusions: Diabetes mellitus 'probably' increases the risk of liver cancer among the Japanese population.Japanese Journal of Clinical Oncology 08/2014; 44(10). DOI:10.1093/jjco/hyu108 · 1.75 Impact Factor
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ABSTRACT: Questions remain about the relationship between type 2 diabetes mellitus (type 2 DM) and the risk of hepatocellular carcinoma (HCC), especially in patients with chronic liver diseases. We carried out a meta-analysis of cohort studies to explore these issues. We searched PubMed and EMBASE for studies on the association between type 2 DM and the risk of HCC through 30 September 2013. We included patients with chronic liver diseases. Summary relative risks with their corresponding 95% confidence intervals (CIs) were calculated using a random-effects model. A total of 21 cohort studies with 24 reports were included in our analysis. After a median duration of follow-up of 6.4 years, a total of 2528 HCC cases were identified in 35 202 participants. The summary relative risk of HCC with type 2 DM was 1.86 (95% CI 1.49-2.31) for patients with chronic liver disease, 1.90 (95% CI 1.37-2.63) for patients with hepatitis C virus infection, 1.93 (95% CI 1.35-2.76) for patients with cirrhosis, and 1.69 (95% CI 0.97-2.92) for patients with hepatitis B virus infection. Subgroup analyses indicated that the positive associations were independent of geographic location, duration of follow-up, and confounding factors such as smoking, alcohol use, and body mass index (BMI). Hepatitis C virus-infected or cirrhotic patients with the concomitant presence of type 2 DM would have a higher risk of developing HCC than those without DM. Therefore, these patients require more active monitoring of the development of HCC.European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 05/2014; 24(2). DOI:10.1097/CEJ.0000000000000038 · 2.76 Impact Factor