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Patients with diabetes, cirrhosis at greater risk for HCC

Having non-hepatitis C virus cirrhosis and diabetes puts patients at a higher risk for developing hepatocellular carcinoma, according to research recently published in The American Journal of Gastroenterology.

“In light of the emerging trends of increasing number of patients with [nonalcoholic fatty liver disease] developing HCC, there is an urgent need to strategize stratifying their risk according to metabolic profile,” W. Ray Kim, MD, division of gastroenterology and hepatology at Stanford University and colleagues wrote.

The study looked at 739 patients with liver cirrhosis, 34% (n = 253) of whom had diabetes. The participants had more than one ultrasound, CT or MRI done on their liver at Mayo Clinic Rochester, Minn. between January 2006 and December 2011.  Researchers followed up with patients an average of 38 months later and reported that:

• 9% (n = 69) of the participants (27 patients with diabetes; 42 without) developed HCC;
• in patients without HCV, diabetes was associated with the risk for developing HCC (HR = 2.1; 95%CI, 1-4.1);
• in patients with HCV, there was no association seen (HR = 0.8; 95%CI, –0.4-1.8;
• the interaction between HCV and diabetes remained significant when adjusted for covariates (HR for non-HCV = 1.9, 95%CI, 0.9-3.7; HR for HCV = 0.6, 95%CI, 0.2-1.3); and
• the failure to make a connection between diabetes and HCC was independently validated in 410 patients with HCV cirrhosis who took part in the HALT-C trial.

The study was not without its limitations, researchers wrote. These included the retrospective nature, participants derived solely from a large referral practice at Mayo Clinic, which may not be indicative of all patients with cirrhosis, a modest number of patients who developed HCC limiting the statistical power, and previous initiation of the HALT-C study before establishing non-invasive diagnostic criteria of HCC. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.