DENVER — Diabetes appears to be an independent risk factor for hepatocellular carcinoma, with the risk rising as duration of the endocrine disease increases, according to an ongoing, prospective case-control study.
Also, the magnitude of risk for hepatocellular carcinoma (HCC) seems to vary substantially with the type of diabetes treatment used. The risk is greatest in patients on sulfonylureas, lowest in those on thiazolidinediones, and intermediate in insulin-treated patients, Dr. Manal M. Hassan reported at the annual meeting of the American Association for Cancer Research.
Dr. Hassan, of the department of gastrointestinal medical oncology at M.D. Anderson Cancer Center, Houston, presented results from a prospective study involving 420 patients with HCC and 1,109 controls who did not have cancer. The prevalence of diabetes was 23.3% among the cancer patients and 10.4% among controls.
In a multivariate logistic regression analysis adjusted for established HCC risk factors such as heavy alcohol consumption, smoking, and hepatitis C infection, as well as for demographic variables, the odds of developing HCC were increased threefold in patients with a 2- to 5-year history of diagnosed diabetes, 4.8-fold for those with a 6- to 10-year diabetes duration, and 6.6-fold for those with more than a 10-year disease duration, compared with nondiabetic individuals.
Subjects on oral hypoglycemic agents had an adjusted 3.6-fold greater risk of HCC than did nondiabetics. The risk of HCC was increased 6.2-fold in insulin-treated patients, 8.7-fold in those on insulin and oral agents, and 28-fold in those managed by diet only.
Among diabetic patients on oral agents, the HCC risk was 20.5-fold greater in those on sulfonylurea drugs than in nondiabetics. In contrast, biguanide therapy was associated with a much lower 2.5-fold increased risk, and thiazolidinediones had a modest 1.3-fold risk, according to Dr. Hassan.