Impact of diabetes mellitus on incidence of hepatocellular carcinoma in chronic hepatitis C patients treated with interferon-based antiviral therapy

International Journal of Cancer
DOI: 10.1002/ijc.25585
Copyright © 2010 UICC

Author Information

Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
Email: Sheng-Nan Lu M.D., M.P.H., Ph.D. (juten@ms17.hinet.net)

*Correspondence: Sheng-Nan Lu M.D., M.P.H., Ph.D., Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital. 123 Ta Pei Road, Niao Sung 833 Kaohsiung, Taiwan
†Ph: 886-7-7317123 ext. 8301; Fax: 886-7-7322402

Publication History
Accepted manuscript online: 28 JUL 2010 12:00AM EST
Manuscript Accepted: 13 JUL 2010
Manuscript Revised: 22 JUN 2010
Manuscript Received: 30 MAR 2010

Funded by
Chang Gung Memorial Hospital, Taiwan. Grant Number: CMRPG880241
 
Keywords:
hepatitis C virus;diabetes mellitus;interferon;hepatocellular carcinoma;survival

Abstract
There is strong evidence linking chronic hepatitis C virus (HCV) infection and type 2 diabetes mellitus (DM). Recent studies have suggested that DM is associated with increased risk of developing hepatocellular carcinoma (HCC). The aim of this cohort study was to assess whether DM influence the incidence of HCC in chronic hepatitis C patients treated with interferon (IFN)-based antiviral therapy. A total of 1,470 chronic hepatitis C patients treated with IFN or pegylated-IFN plus ribavirin therapy were enrolled. Of them, 253 (17%) patients had DM at entry. Evaluation of HCC incidence was performed by Kaplan-Meier method and Cox proportional hazards analysis. Patients with baseline DM were significantly older and had higher body mass index, serum transaminase levels and fibrosis scores and lower platelet counts compared with non-DM subjects. Sustained virological response (SVR) was achieved in 160 (63%) of DM and 867 (71%) of non-DM patients (P=0.008). During a median follow-up period of 4.3 years, HCC developed in 21 (8.3%) of DM and 66 (5.4%) of non-DM patients (P=0.017). However, DM was not an independent covariate by Cox proportional hazards analysis. In a subgroup analysis, DM (hazard ratio, 4.32; 95% confidence interval, 1.23-15.25; P=0.023) was an independent predictor of HCC in the SVR patients without baseline cirrhosis, despite a low HCC incidence. In conclusion, DM has a selective impact on HCC development among chronic hepatitis C patients after IFN-based therapy. DM may increase the HCC risk in chronic hepatitis C without cirrhosis after eradication of HCV.

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