Association of thiazolidinediones with liver cancer and... : Hepatology (original) (raw)

Hepatobiliary Malignancies

Association of thiazolidinediones with liver cancer and colorectal cancer in type 2 diabetes mellitus

Chang, Chia-Hsuin1,2,†; Lin, Jou-Wei2,3,†; Wu, Li-Chiu4; Lai, Mei-Shu4,*; Chuang, Lee-Ming1,2; Chan, K. Arnold5

1 From the Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

2 Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

3 Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan

4 Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

5 Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

* Address reprint requests to: Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. E-mail:[email protected]or[email protected]; fax: 886-2-2392-0456, or Professor Lee-Ming Chuang, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

E-mail:[email protected].

Received 8 June 2011; Accepted 17 November 2011

Potential conflict of interest: Nothing to report.

Supported in part by Taiwan Department of Health grant DOH098-TD-D-113-098016, which did not play any role in our study design, collection, analysis, and interpretation of data, in report writing, or in the decision to submit the article for publication. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the Department of Health, Executive Yuan, Taiwan.

† These authors contributed equally to this work.

Additional Supporting Information may be found in the online version of this article.

View this article online atwileyonlinelibrary.com.

Abstract

The objective of this nationwide case-control study was to evaluate the risk of specific malignancy in diabetic patients who received thiazolidinediones (TZDs). A total of 606,583 type 2 diabetic patients, age 30 years and above, without a history of cancer were identified from the Taiwan National Health Insurance claims database during the period between January 1 2000 and December 31 2000. As of December 31 2007, patients with incident cancer of liver, colorectal, lung, and urinary bladder were included as cases and up to four age- and sex-matched controls were selected by risk-set sampling. Logistic regression models were applied to estimate the odds ratio (OR) and 95% confidence interval (CI) between TZDs and cancer incidence. A total of 10,741 liver cancer cases, 7,200 colorectal cancer cases, and 70,559 diabetic controls were included. A significantly lower risk of liver cancer incidence was found for any use of rosiglitazone (OR: 0.73, 95% CI: 0.65-0.81) or pioglitazone (OR: 0.83, 95% CI: 0.72-0.95), respectively. The protective effects were stronger for higher cumulative dosage and longer duration. For colorectal cancer, rosiglitazone, but not pioglitazone, was associated with a significantly reduced risk (OR: 0.86; 95% CI: 0.76-0.96). TZDs were not associated with lung and bladder cancer incidence, although a potential increased risk for bladder cancer with pioglitazone use ≥3 years could not be excluded (OR: 1.56; 95% CI: 0.51-4.74).

Conclusion:

The use of pioglitazone and rosiglitazone is associated with a decreased liver cancer incidence in diabetic patients. The effects on occurrence of specific cancer types may be different for pioglitazone and rosiglitazone. (Hepatology 2012;)