Metabolic syndrome increases the risk of primary liver cancer in the United States: A study in the SEER-medicare database

Authors

  • Tania M. Welzel,

    Corresponding author
    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
    2. Klinikum der J.W. Goethe-Universität Frankfurt am Main, Medizinische Klinik 1, Frankfurt am Main, Germany
    • Klinikum der J.W. Goethe-Universität Frankfurt am Main, Medizinische Klinik 1, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany and Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 6120 Executive Boulevard, EPS/Suite 550, MSC-7234, Bethesda, MD 20892
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    • fax: +49-000-00000

  • Barry I. Graubard,

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
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  • Stefan Zeuzem,

    1. Klinikum der J.W. Goethe-Universität Frankfurt am Main, Medizinische Klinik 1, Frankfurt am Main, Germany
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  • Hashem B. El-Serag,

    1. Sections of Health Services Research and Gastroenterology, Michael E. Debakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX
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  • Jessica A. Davila,

    1. Sections of Health Services Research and Gastroenterology, Michael E. Debakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX
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  • Katherine A. McGlynn

    1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD
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  • Potential conflict of interest: Dr. Zeuzem is a consultant for, advises, and received grants from Bristol-Myers Squibb. He is a consultant for and advsies Bayer. He also received grants from Human Genome Sciences.

  • This article is a US Government work and is in the public domain in the USA.

Abstract

Incidence rates of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) have increased in the United States. Metabolic syndrome is recognized as a risk factor for HCC and a postulated one for ICC. The magnitude of risk, however, has not been investigated on a population level in the United States. We therefore examined the association between metabolic syndrome and the development of these cancers. All persons diagnosed with HCC and ICC between 1993 and 2005 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. For comparison, a 5% sample of individuals residing in the same regions as the SEER registries of the cases was selected. The prevalence of metabolic syndrome as defined by the U.S. National Cholesterol Education Program Adult Treatment Panel III criteria, and other risk factors for HCC (hepatitis B virus, hepatitis C virus, alcoholic liver disease, liver cirrhosis, biliary cirrhosis, hemochromatosis, Wilson's disease) and ICC (biliary cirrhosis, cholangitis, cholelithiasis, choledochal cysts, hepatitis B virus, hepatitis C virus, alcoholic liver disease, cirrhosis, inflammatory bowel disease) were compared among persons who developed cancer and those who did not. Logistic regression was used to calculate odds ratios and 95% confidence intervals. The inclusion criteria were met by 3649 HCC cases, 743 ICC cases, and 195,953 comparison persons. Metabolic syndrome was significantly more common among persons who developed HCC (37.1%) and ICC (29.7%) than the comparison group (17.1%, P < 0.0001). In adjusted multiple logistic regression analyses, metabolic syndrome remained significantly associated with increased risk of HCC (odds ratio = 2.13; 95% confidence interval = 1.96-2.31, P < 0.0001) and ICC (odds ratio = 1.56; 95% confidence interval = 1.32-1.83, P < 0.0001). Conclusion: Metabolic syndrome is a significant risk factor for development of HCC and ICC in the general U.S. population. (HEPATOLOGY 2011;)

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