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Hepatocellular carcinoma development in diabetic patients: a nationwide survey in Japan
- Source :
- Journal of Gastroenterology
- Publication Year :
- 2021
- Publisher :
- Springer Singapore, 2021.
-
Abstract
- Background Although type 2 diabetes mellitus (T2DM) is a known risk factor for hepatocellular carcinoma (HCC) development, the annual incidence in diabetes patients is far below the threshold of efficient surveillance. This study aimed to elucidate the risk factors for HCC in diabetic patients and to determine the best criteria to identify surveillance candidates. Methods The study included 239 patients with T2DM who were diagnosed with non-viral HCC between 2010 and 2015, with ≥ 5 years of follow-up at diabetes clinics of 81 teaching hospitals in Japan before HCC diagnosis, and 3277 non-HCC T2DM patients from a prospective cohort study, as controls. Clinical data at the time of and 5 years before HCC diagnosis were collected. Results The mean patient age at HCC diagnosis was approximately 73 years, and 80% of the patients were male. The proportion of patients with insulin use increased, whereas the body mass index (BMI), proportion of patients with fatty liver, fasting glucose levels, and hemoglobin A1c (HbA1c) levels decreased significantly in 5 years. In the cohort study, 18 patients developed HCC during the mean follow-up period of 4.7 years with an annual incidence of 0.11%. Multivariate logistic regression analyses showed that the FIB-4 index was an outstanding predictor of HCC development along with male sex, presence of hypertension, lower HbA1c and albumin levels, and higher BMI and gamma-glutamyl transpeptidase levels. Receiver-operating characteristic analyses showed that a FIB-4 cut-off value of 3.61 could help identify high-risk patients, with a corresponding annual HCC incidence rate of 1.1%. Conclusion A simple calculation of the FIB-4 index in diabetes clinics can be the first step toward surveillance of HCC with a non-viral etiology.
- Subjects :
- Male
medicine.medical_specialty
Carcinoma, Hepatocellular
Hepatocellular carcinoma
FIB-4 index
Cohort Studies
Diabetes Complications
Japan
Diabetes mellitus
Internal medicine
Surveys and Questionnaires
Type 2 diabetes mellitus
Medicine
Humans
Registries
Risk factor
Prospective cohort study
Aged
Original Article—Liver, Pancreas, and Biliary Tract
business.industry
Fatty liver
Liver Neoplasms
Gastroenterology
Type 2 Diabetes Mellitus
Middle Aged
medicine.disease
digestive system diseases
Logistic Models
Diabetes Mellitus, Type 2
ROC Curve
Female
business
Body mass index
Cohort study
Subjects
Details
- Language :
- English
- ISSN :
- 14355922 and 09441174
- Volume :
- 56
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Journal of Gastroenterology
- Accession number :
- edsair.doi.dedup.....ddd0e41619779b57072cbfac58ac44c7