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ScienceDaily (May 29, 2008) — Patients who
have chronic hepatitis C with advanced fibrosis have twice the risk of
developing liver cancer if they also have diabetes.
Recent studies have suggested that diabetes increases one’s risk for
hepatocellular carcinoma (HCC), also known as liver cancer, possibly
because diabetes often occurs as part of the metabolic syndrome, which
increases the risk of non-alcoholic steatohepatitis (NASH), which can
lead to liver cancer. Chronic hepatitis C also increases the risk of
liver cancer, so patients who have both diabetes and hepatitis C have
two pathways through which HCC might develop.
Researchers led by Bart Veldt and Harry Janssen of the Erasmus MC
University Medical Center in the Netherlands, aimed to quantify the
liver cancer risk of patients who have both diabetes mellitus and
advanced hepatitis C. They used data from five large hepatology units
in Europe and Canada and included 541 consecutive patients between 1990
and 2003 who had chronic hepatitis C and advanced liver fibrosis or
cirrhosis as shown by liver biopsy. For each patient, they gathered
demographic, clinical, biochemical and virological data, along with
fibrosis assessment and details of hepatitis C treatment.
Eighty-five of the 541 patients included in the study had diabetes.
Patients with more severe fibrosis were more likely to be diabetic.
“The prevalence of diabetes mellitus was 10.5 percent for patients with
Ishak fibrosis score 4, 12.5 percent for Ishak-score 5 and 19.1 percent
for Ishak-score 6,” the authors report.
During the median follow-up time of four years, 11 patients (13
percent) with diabetes vs. 27 patients (5.9 percent) without diabetes
developed hepatocellular carcinoma. The 5-year occurrence was 11.4
percent and 5.0 percent, respectively. Male gender and older age were
significantly associated with elevated HCC risk. “In addition, there
was a strong trend towards a higher incidence of HCC among patients
with diabetes mellitus,” the authors report. Multivariate Cox
regression analysis of patients with Ishak 6 cirrhosis showed that
diabetes was independently associated with the development of HCC.
Interestingly, among patients with diabetes, there was a trend
towards higher risk of HCC as fasting glucose levels increased. The
authors hypothesize that resulting hyperinsulinemia might help explain
the increased risk of HCC among diabetic patients.
Whatever the mechanism, the risk is clear. “For patients with
chronic hepatitis C and advanced cirrhosis, diabetes mellitus increases
the risk of developing HCC,” the authors conclude.
http://www.sciencedaily.com/releases/2008/05/080529162901.htm
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