Neil Osterweil

October 21, 2015

HONOLULU — Diabetes and hypertension are both independent risk factors for hepatocellular carcinoma, even in the absence of cirrhosis or the common causes of cirrhosis, according to a retrospective study.

Does this mean we should "screen patients with diabetes mellitus and hypertension for hepatocellular carcinoma in the absence of cirrhosis, and will this be cost-effective?" asked Allison Kasmari, MD, a gastroenterology resident at Penn State Hershey Medical Center in Pennsylvania.

Previous studies have suggested that diabetes increases the risk for hepatocellular carcinoma, prompting Dr Kasmari and her colleagues to investigate whether other components of the metabolic syndrome — such as hypertension and hyperlipidemia — increase risk.

She presented the results here at the American College of Gastroenterology (ACG) 2015 Annual Meeting.

The team retrospectively identified 17,446 patients of hepatocellular carcinoma diagnosed from 2008 to 2012 in the MarketScan Health Claims database.

The final study cohort consisted of 7473 patients, after the exclusion of those with possible confounders, such as cirrhosis, hepatitis B, alcoholic liver damage, nonalcoholic fatty liver disease, and some autoimmune and hereditary conditions.

The 22,110-person control group provided about three age- and sex- matched subjects for each patient with hepatocellular carcinoma.

Hepatitis C Link

The researchers found that diabetes is associated with the development of hepatocellular carcinoma (odds ratio [OR], 1.353), as are hypertension (OR, 1.229) and hepatitis C (OR, 2.102).

In contrast, hyperlipidemia appears to be protective against hepatocellular carcinoma (OR, 0.885).

There was a significant association between some diabetes medications, such as insulin, and an increased risk for hepatocellular carcinoma (OR, 1.640). But for other diabetes medications, such as metformin, there was a significant decreased risk (OR, 0.706).

In subanalyses, the researchers found a fourfold increase in the risk for hepatocellular carcinoma in patients with the combination of diabetes, hypertension, and hepatitis C (OR, 4.580). The risk was also elevated in patients with just diabetes and hypertension (OR, 3.399).

Risks were also elevated in patients with diabetes, hyperlipidemia, and hepatitis C (OR, 2.319), and in patients with diabetes and hyperlipidemia (OR, 2.395).

Dr Kasmari acknowledged that the patient population in this study is relatively young (range, 16 to 64 years), and that insurance claims data, compared with data from other sources, could have led to underestimates of some conditions.

In addition, the team was unable to look at obesity as a variable in their analysis, because obesity is not commonly coded as a diagnosis, she reported.

The finding that some diabetes medications are detrimental and some are protective is intriguing, said John Saltzman, MD, from Brigham and Women's Hospital in Boston, who is chair of the ACG educational affairs committee and who selected the abstract for presentation.

"Diabetes and hypertension were predictive of hepatocellular carcinoma, but I'm not sure I understand the mechanism of hypertension [in the disease]," he told Medscape Medical News.

"Are these modifiable risks?" he asked. "If you have a patient who has these things and you treat them, can you reduce those risks?"

The study funding source was not disclosed. Dr Kasmari and Dr Saltzman have disclosed no relevant financial relationships.

American College of Gastroenterology (ACG) 2015 Annual Meeting: Abstract 1. Presented October 19, 2015.


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