TY - JOUR
T1 - Hepatocellular carcinoma development in diabetic patients
T2 - a nationwide survey in Japan
AU - for the LUCID study investigators
AU - Tateishi, Ryosuke
AU - Matsumura, Takeshi
AU - Okanoue, Takeshi
AU - Shima, Toshihide
AU - Uchino, Koji
AU - Fujiwara, Naoto
AU - Senokuchi, Takafumi
AU - Kon, Kazuyoshi
AU - Sasako, Takayoshi
AU - Taniai, Makiko
AU - Kawaguchi, Takumi
AU - Inoue, Hiroshi
AU - Watada, Hirotaka
AU - Kubota, Naoto
AU - Shimano, Hitoshi
AU - Kaneko, Shuichi
AU - Hashimoto, Etsuko
AU - Watanabe, Sumio
AU - Shiota, Goshi
AU - Ueki, Kohjiro
AU - Kashiwabara, Kosuke
AU - Matsuyama, Yutaka
AU - Tanaka, Hideo
AU - Kasuga, Masato
AU - Araki, Eiichi
AU - Koike, Kazuhiko
AU - Karino, Yoshiyasu
AU - Hige, Shuhei
AU - Sekiguchi, Masatomo
AU - Ogawa, Koji
AU - Miyoshi, Hideaki
AU - Cho, Kyu Yong
AU - Baba, Masaru
AU - Inoue, Atsushi
AU - Aso, Kazuobu
AU - Okada, Mitsuyoshi
AU - Takikawa, Yasuhiro
AU - Endo, Kei
AU - Ishigaki, Yasushi
AU - Togashi, Hirobumi
AU - Unno, Michiaki
AU - Morikawa, Takanori
AU - Katagiri, Hideki
AU - Sawada, Shojiro
AU - Ohira, Hiromasa
AU - Takahashi, Atsushi
AU - Shimabukuro, Michio
AU - Kudo, Akihiro
AU - Kawabe, Naoto
AU - Kakita, Ayako
N1 - Publisher Copyright:
© 2021, The Author(s).
PY - 2021/3
Y1 - 2021/3
N2 - 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.
AB - 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.
KW - FIB-4 index
KW - Hepatocellular carcinoma
KW - Type 2 diabetes mellitus
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U2 - 10.1007/s00535-020-01754-z
DO - 10.1007/s00535-020-01754-z
M3 - Article
C2 - 33427937
AN - SCOPUS:85100141499
SN - 0944-1174
VL - 56
SP - 261
EP - 273
JO - Journal of Gastroenterology
JF - Journal of Gastroenterology
IS - 3
ER -