The Impact of Type 2 Diabetes on the Development of Hepatocellular Carcinoma in Different Viral Hepatitis Statuses
- 1Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; 2A-Lein Community Health Center, Kaohsiung County, Taiwan; 3Department of Radiology, Division of Gastroenterology, 4Department of Internal Medicine and Institute of Clinical Medicine, and 5Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Requests for reprints:
Pesus Chou, Community Medicine Research Center and Institute of Public Health, National Yang Ming University, Shih-Pai, Taipei 112, Taiwan. Phone: 886-2-2822-9695; Fax: 886-2-2820-1461. E-mail: pschou{at}ym.edu.tw
Abstract
Background: The risk of type 2 diabetes on the development of hepatocellular carcinoma remains inconclusive in different hepatitis statuses.
Methods: We prospectively followed a community-based cohort with 5,929 persons in southern Taiwan from January 1997 through December 2004, made up of 4,117 seronegative, 982 anti–hepatitis C virus–positive [HCV(+)], 696 hepatitis B surface antigen–positive [HBsAg(+)], and 134 coinfected persons. Before the study, 546 participants had developed diabetes. Hepatocellular carcinoma diagnoses were from the National Cancer Registry.
Results: After 50,899 person-years of follow-up, 111 individuals had developed hepatocellular carcinoma. The highest risk of hepatocellular carcinoma, compared with seronegative individuals without diabetes, was in anti-HCV(+) individuals with diabetes [incidence rate ratio (IRR), 76.0], then coinfected (IRR, 46.0), anti-HCV(+) without diabetes (IRR, 26.1), HBsAg(+) with diabetes (IRR, 21.4), and seronegative with diabetes (IRR, 7.2; P < 0.001). Anti-HCV(+) (n = 132) and seronegative individuals (n = 352) with diabetes had a higher cumulative incidence rate of hepatocellular carcinoma than those without diabetes (log-rank test, P < 0.001). Multivariate Cox proportional hazards analysis showed that gender, age, body mass index ≥30, HBsAg(+) [hazards ratio (HR), 12.6], anti-HCV(+) (HR, 18.8), coinfection (HR, 25.9), and diabetes [HR, 2.7; 95% confidence interval (95% CI), 1.7-4.3] were independent predictors of hepatocellular carcinoma (P < 0.05). After stratifying hepatitis status in multivariate Cox analysis, diabetes was significant for seronegative (HR, 5.4; 95% CI, 1.7-17.1) and anti-HCV(+) individuals (HR, 3.1; 95% CI, 1.7-5.4). Body mass index ≥30 was significant for HBsAg(+) individuals (HR, 3.3; 95% CI, 1.3-8.1).
Conclusion: Type 2 diabetes is a strong independent predictor of hepatocellular carcinoma in anti-HCV(+) and seronegative individuals but not in HBsAg(+) individuals. (Cancer Epidemiol Biomarkers Prev 2009;18(7):2054–60)
Footnotes
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Grant support: A-Lein Community Health Promotion Committee, the Kaohsiung Bureau of Health, and the C. T. Hsu Cancer Research Foundation.
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- Accepted April 30, 2009.
- Received December 11, 2008.
- Revision received April 27, 2009.
