Increased risk of hepatocellular carcinoma among patients with hepatitis C cirrhosis and diabetes mellitus

Authors

  • Bart J. Veldt,

    1. Erasmus MC University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
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  • Wendong Chen,

    1. Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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  • E. Jenny Heathcote,

    1. Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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  • Heiner Wedemeyer,

    1. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
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  • Juerg Reichen,

    1. Institute of Clinical Pharmacology, University of Berne, Berne, Switzerland
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  • W. Peter Hofmann,

    1. Saarland University Hospital, Department of Internal Medicine II, Homburg/Saar, Germany
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  • Robert J. de Knegt,

    1. Erasmus MC University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
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  • Stefan Zeuzem,

    1. Saarland University Hospital, Department of Internal Medicine II, Homburg/Saar, Germany
    Current affiliation:
    1. Johann Wolfgang Goethe University Hospital, Department of Internal Medicine I, Frankfurt am Main, Germany
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  • Michael P. Manns,

    1. Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover, Hannover, Germany
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  • Bettina E. Hansen,

    1. Erasmus MC University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
    2. Erasmus MC University Medical Center, Department of Epidemiology and Biostatistics, Rotterdam, the Netherlands
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  • Solko W. Schalm,

    1. Erasmus MC University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
    Current affiliation:
    1. ExpertDoc-LiverDoc, Rotterdam, the Netherlands
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  • Harry L. A. Janssen

    Corresponding author
    1. Erasmus MC University Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, the Netherlands
    • Erasmus MC University Medical Center, Department of Gastroenterology and Hepatology, Room Ca 326a, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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    • fax: 31 10 4365916


  • Potential conflict of interest: Nothing to report.

Abstract

Recent studies suggest that diabetes mellitus increases the risk of developing hepatocellular carcinoma (HCC). The aim of this study is to quantify the risk of HCC among patients with both diabetes mellitus and hepatitis C in a large cohort of patients with chronic hepatitis C and advanced fibrosis. We included 541 patients of whom 85 (16%) had diabetes mellitus. The median age at inclusion was 50 years. The prevalence of diabetes mellitus was 10.5% for patients with Ishak fibrosis score 4, 12.5% for Ishak score 5, and 19.1% for Ishak score 6. Multiple logistic regression analysis showed an increased risk of diabetes mellitus for patients with an elevated body mass index (BMI) (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.00-1.11; P = 0.060) and a decreased risk of diabetes mellitus for patients with higher serum albumin levels (OR, 0.81; 95% CI, 0.63-1.04; P = 0.095). During a median follow-up of 4.0 years (interquartile range, 2.0-6.7), 11 patients (13%) with diabetes mellitus versus 27 patients (5.9%) without diabetes mellitus developed HCC, the 5-year occurrence of HCC being 11.4% (95% CI, 3.0-19.8) and 5.0% (95% CI, 2.2-7.8), respectively (P = 0.013). Multivariate Cox regression analysis of patients with Ishak 6 cirrhosis showed that diabetes mellitus was independently associated with the development of HCC (hazard ratio, 3.28; 95% CI, 1.35-7.97; P = 0.009). Conclusion: For patients with chronic hepatitis C and advanced cirrhosis, diabetes mellitus increases the risk of developing HCC. (HEPATOLOGY 2008;47:1856–1862.)

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