Diabetes Is Associated With Increased Risk of... : Hepatology (original) (raw)

Original Articles: HEPATOBILIARY MALIGNANCIES

Diabetes Is Associated With Increased Risk of Hepatocellular Carcinoma in Patients With Cirrhosis From Nonalcoholic Fatty Liver Disease

Yang, Ju Dong1,2,3,4; Ahmed, Fowsiyo1; Mara, Kristin C.5; Addissie, Benyam D.6; Allen, Alina M.1; Gores, Gregory J.1; Roberts, Lewis R.*,1

1Division of Gastroenterology and HepatologyMayo Clinic College of Medicine and ScienceRochesterMN

2Division of Digestive and Liver Diseases, Department of Internal MedicineCedars‐Sinai Medical CenterLos AngelesCA

3Comprehensive Transplant CenterCedars Sinai Medical CenterLos AngelesCA

4Samuel Oschin Comprehensive Cancer InstituteCedars Sinai Medical CenterLos AngelesCA

5Department of Health Science ResearchMayo Clinic College of Medicine and ScienceRochesterMN

6Division of Gastroenterology and HepatologyGeisinger Medical CenterDanvillePA

*Address Correspondence and Reprint Requests to:
Lewis R. Roberts, M.B., Ch.B., Ph.D.
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science
200 First Street Southwest
Rochester, MN 55905
E‐mail: [email protected]
Tel.: +1‐507‐266‐3239

Abstract

Diabetes increases the risk of liver disease progression and cirrhosis development in patients with nonalcoholic steatohepatitis (NASH). The association between diabetes and the risk of hepatocellular carcinoma (HCC) in NASH patients with cirrhosis is not well quantified. All patients with the diagnosis of NASH cirrhosis seen at Mayo Clinic Rochester between January 2006 and December 2015 were identified. All adult liver transplant registrants with NASH between 2004 and 2017 were identified using the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation registry for external validation. Cox proportional hazard analysis was performed to investigate the association between diabetes and HCC risk. Among 354 Mayo Clinic patients with NASH cirrhosis, 253 (71%) had diabetes and 145 (41%) were male. Mean age at cirrhosis evaluation was 62. During a median follow‐up of 47 months, 30 patients developed HCC. Diabetes was associated with an increased risk of developing HCC in univariate (hazard ratio [HR] = 3.6; 95% confidence interval [CI] = 1.1‐11.9; P = 0.04) and multivariable analysis (HR = 4.2; 95% CI = 1.2‐14.2; P = 0.02). In addition, age (per decade, HR = 1.8; 95% CI = 1.2‐2.6; P < 0.01) and low serum albumin (HR = 2.1; 95% CI = 1.5‐2.9; P < 0.01) were significantly associated with an increased risk of developing HCC in multivariable analysis. Other metabolic risk factors, including body mass index, hyperlipidemia, and hypertension, were not associated with HCC risk. Among UNOS NASH registrants (N = 6,630), 58% had diabetes. Diabetes was associated with an increased risk of developing HCC in univariate (HR = 1.4; 95% CI = 1.1‐1.8; P < 0.01) and multivariable (HR = 1.3; 95% CI = 1.0‐1.7; P = 0.03) analysis. Conclusion: Diabetes is associated with an increased risk of HCC in patients with NASH cirrhosis.