medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2008, Number 2

<< Back Next >>

Ann Hepatol 2008; 7 (2)

Impact of diabetes mellitus on outcome of HCC

Amarapurkar DN, Patelm ND, Kamani PM

Language: English
References: 55
Page: 148-151
PDF size: 126.58 Kb.


Text Extraction

Background: Diabetes mellitus (DM) is recently identified risk factor for development and progression of chronic liver disease as well as hepatocellular carcinoma (HCC). We planned a prospective analysis to identify impact of DM in Indian patients with HCC. Methods: During last 10 years, 160 consecutive patients of HCC were evaluated. Demographic profile like age of presentation, clinical features, etiology of HCC, tumor size at presentation, management and ultimate outcome was compared diabetic with non-diabetic HCC patients. Results: During last 10 years, 160 consecutive patients of HCC were evaluated (Mean age = 59.6 ± 12.9 years, sex ratio (M: F) = 5.4: 1). Etiology for HCC were hepatitis B in 45 (28.2%), hepatitis C in 18 (11.3%), alcohol in 27 (16.8%), alcohol with hepatitis B in 12 (7.5%), alcohol with hepatitis C in 1 (0.6%), non-alcoholic steatohepatitis in 4 (2.5%) and cryptogenic in 53 (33.2%) patients. Patients of HCC with DM (group-A, n =46, age = 62.6 ± 9.5 years, sex (M: F) = 6.6:1) were compared with patient of HCC without DM (group-B, n =114, age = 66.7 ± 13.7 years, sex (M: F) = 5.4:1). Duration of diabetes in group-A was 7.6 ± 3.2 years. Patients in group-A had more advanced HCC (size of lesion › 5 cm and ›3 lesions of 3 cm or more diameter, portal vein thrombosis or intra-hepatic bile duct involvement) than group-B [34 (73.9%) vs 72 (54.3%)]. Mortality with in one year was significantly more in group-A compared to group-B [36 (78.2%) vs 56 (49.1%)]. Conclusion: DM is associated with more advanced lesion and poor outcome in patient with HCC.


REFERENCES

  1. El-Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology 2004; 126: 460-468.

  2. Amarapurkar D, Das HS. Chronic liver disease in diabetes mellitus. Tropical Gastroenterol 2002; 23: 3-5.

  3. Ruhl CE, Everhart JE. Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. Gastroenterology 2003; 124: 71-79.

  4. Di Bisceglie AM, Carithers Jr RL, Gores GL. Hepatocellular carcinoma. Hepatology 1998; 28: 1161-1165.

  5. El-Serag HB, Richardson PA, Everhart JE. The role of diabetes in hepatocellular carcinoma: a case-control study among United States veterans. Am J Gastroenterol 2001; 96: 2462-2467.

  6. Kessler II. Cancer mortality among diabetics. J Natl Cancer Inst 1970; 44: 2051-2055.

  7. Ragozzino M, Melton III LJ, Chu CP, Palumbo PJ. Subsequent cancer risk in the incidence cohort of Rochester, Minnesota, residents with diabetes mellitus. J Chronic Dis 1982; 35: 13-19.

  8. Lu SN, Lin TM, Chen CJ, Chen JS, Liaw YF, Chang WY, et al. A case-control study of primary hepatocellular carcinoma in Taiwan. Cancer 1988; 62: 2051-2055.

  9. Beasley RP. Diabetes and hepatocellular carcinoma. Hepatology 2006; 44: 1408-1410.

  10. El–Serag HB, Hampel H, Javadi F. The Association Between Diabetes and Hepatocellular Carcinoma: A Systematic Review of Epidemiologic Evidence. Clin Gastroenterol Hepatol 2006; 4: 369-380.

  11. La Vecchia C, Negri E, D’Avanzo B, Boyle P, Franceschi SD. Medical history and primary liver cancer. Cancer Res 1990; 50: 6274-6277.

  12. La Vecchia C, Negri E, Franceschi SD, D’Avanzo B, Boyle P. A case-control study of diabetes mellitus and cancer risk. Br J Cancer 1994; 70: 950-953.

  13. La Vecchia C, Negri E, DeCarli A, Franceschi SD. Diabetes mellitus and the risk of primary liver cancer. Int J Cancer 1997; 73: 204-207.

  14. Adami HO, McLaughlin J, Ekbom A, Berne C, Silverman D, Hacker D, et al. Cancer risk in patients with diabetes mellitus. Cancer Causes Control 1991; 2: 307-314.

  15. Adami HO, Chow WH, Nyren O, Berne C, Linet MS, Ekbom A, et al. Excess risk of primary liver cancer in patients with diabetes mellitus. J Natl Cancer Inst 1996; 88: 1472-1477.

  16. Kingston ME, Ali MA, Atiyeh M, Donnelly RJ. Diabetes mellitus in chronic active hepatitis and cirrhosis. Gastroenterology 1984; 87: 688-694.

  17. Lawson DH, Gray JM, McKillop C, Clarke J, Lee FD, Patrick RS. Diabetes mellitus and primary hepatocellular carcinoma. Q J Med 1986; 61: 945-955.

  18. Davila JA, Morgan RO, Shaib Y, et al. Diabetes increases the risk of hepatocellular carcinoma in the United States: a population based case control study. Gut 2005; 54: 533-539.

  19. Yu MC, Tong MJ, Govindarajan S, Henderson BE. Non-viral risk factors for hepatocellular carcinoma in a low-risk population, the non-Asians of Los Angeles County, California. J Natl Cancer Inst 1991; 83: 1820-1826.

  20. Braga C, La Vecchia C, Negri E, Franceschi S. Attributable risks for hepatocellular carcinoma in Northern Italy. Eur J Cancer 1997; 33: 629-634.

  21. Wideroff L, Gridley G, Mellemkjaer L, Chow WH, Linet M, Keehn S, et al. Cancer incidence in a population-based cohort of patients hospitalized with diabetes mellitus in Denmark. J Natl Cancer Inst 1997; 89: 1360-1365.

  22. Lagiou P, Kuper H, Stuver S, Tzonou A, Trichopoulos D, Adami HO. Role of diabetes mellitus in the etiology of hepatocellular carcinoma. J Natl Cancer Inst 2000; 92: 1096-1099.

  23. Fujino Y, Mizoue T, Tokui N, Yoshimura T. Prospective study of diabetes mellitus and liver cancer in Japan. Diabetes Metab Res Rev 2001; 17: 374-379.

  24. Tazawa J, Maeda M, Nakagawa M, Ohbayashi H, Kusano F, Yamane M, et al. Diabetes mellitus may be associated with hepatocarcinogenesis in patients with chronic hepatitis C. Dig Dis Sci 2002; 47: 710-715.

  25. Hassan M, Hwang L, Hatten C, Swaim M, Li D, Abbruzzese J, et al. Risk factors for hepatocellular carcinoma: synergism of alcohol with viral hepatitis and diabetes mellitus. Hepatology 2002; 36: 1206-1213.

  26. Lai MS, Hsieh MS, Chiu YH, Chen TH. Type 2 diabetes and hepatocellular carcinoma: a cohort study in high prevalence area of hepatitis virus infection. Hepatology 2006; 43: 1295-1302.

  27. Harrison SA. Liver disease in patients with diabetes mellitus. J Clin Gastroenterol 2006; 40: 68-76.

  28. Kaczynski J, Hansson G, Wallerstedt S. Diabetes: one of few remarkable differences in clinicopathologic features between cirrhotic and noncirrhotic Swedes with hepatocellular carcinoma. Dig Dis Sci 2006; 51: 796-802.

  29. Di Bisceglie AM. What every hepatologist should know about endocrinology: Obesity, diabetes, and liver disease. Gastroenterology 2004; 126: 604-606.

  30. Matteoni C, Younossi Z, Gramlich T, Bopari N, Liu Y, McCullough A. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology 1999; 116: 1413-1419.

  31. Marchesini G, Brizi M, Morselli-Labate A, Bianchi G, Bugianesi E, McCullough A, et al. Association of nonalcoholic fatty liver disease with insulin resistance. Am J Med 1999; 107: 450-455.

  32. Belfiore F, Iannello S. Insulin resistance in obesity: metabolic mechanisms and measurement methods. Mol Genet Metab 1998; 65: 121-128.

  33. Falck-Ytter, Younossi Z, Marchesini G, McCullough A. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis 2001; 21: 17-26.

  34. Powell E, Cooksley W, Hanson R, Searle J, Halliday J, Powell L. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology 1990; 11: 74-80.

  35. Cotrim H, Parana R, Braga E, Lyra L. Nonalcoholic steatohepatitis and hepatocellular carcinoma: natural history? Am J Gastroenterol 2000; 95: 3018-3019.

  36. Zen Y, Katayanagi K, Tsuneyama K, Harada K, Araki I, Nakanuma Y. Hepatocellular carcinoma arising in non-alcoholic steatohepatitis. Pathol Int 2001; 51: 127-131.

  37. Shimada M, Hashimoto E, Taniai M, Hasegawa K, Okuda H, Yayashi N, et al. Hepatocellular carcinoma in patients with non-alcoholic steatohepatitis. J Hepatol 2002; 37: 154-160.

  38. Harris MI, Klein R, Welborn TA, Knuiman MW. Onset of NIDDM occurs at least 4–7 years before clinical diagnosis. Diabetes Care 1992; 15: 815-819.

  39. Iyer SR. Type 2 diabetes mellitus express highway, where is the ‘U’ turn? JAPI 2003; 51: 495-500.

  40. Bianchi G, Marchesini G, Zoli M, Bugianesi E, Fabbri A, Pisi E. Prognostic significance of diabetes in patients with cirrhosis. Hepatology 1994; 20: 119-25.

  41. Huo T-I, Lui W-Y, Huang Y-H, et al. Diabetes mellitus is a risk factor for hepatic decompensation in patients with hepatocellular carcinoma undergoing resection: a longitudinal study. Am J Gastroenterol 2003; 98: 2293-2298.

  42. Huo T-I, Wu J-C, Lui W-Y, et al. Differential mechanism and prognostic impact of diabetes mellitus on patients with hepatocellular carcinoma undergoing surgical and nonsurgical treatment. Am J Gastroenterol 2004; 99: 1479-1487.

  43. Toyoda H, Kumada T, Nakano S, et al. Impact of diabetes mellitus on the prognosis of patients with hepatocellular carcinoma. Cancer 2001; 91: 957-963.

  44. Ikeda Y, Shimada M, Hasegawa H, et al. Prognosis of hepatocellular carcinoma with diabetes mellitus after hepatic resection. Hepatology 1998; 27: 1567-1571.

  45. Poon RT, Fan ST, Wong J. Does diabetes mellitus influence the perioperative outcome or long-term prognosis after resection of hepatocellular carcinoma? Am J Gastroenterol 2002; 97: 1480-1488.

  46. Shimada M, Matsumata T, Akazawa K, et al. Estimation of risk of major complications after hepatic resections. Am J Surg 1994; 167: 339-403.

  47. Yanaga K, Matsumata T, Hayashi H, et al. Effect of diabetes mellitus on hepatic resection. Arch Surg 1993; 128: 445-448.

  48. Moore MA, Park CB, Tsuda H. Implication of the hyperinsulinemia-diabetes-cancer link for preventive effect. Eur J Cancer Prev 1998; 7: 89-107.

  49. Kim SO, Park GJ, Lee YI. Increased expression of the insulin like growth factor receptor –I (IGF-1) receptor gene in hepatocellular carcinoma cell lines: implication of IGF-I receptor gene activation by hepatitis B virus X gene products. Cancer Res 1996; 56: 3831-36.

  50. Kaburagi Y, Yamachui T, Yamamoto-Honda R, et al. The mechanism of insulin-induced signal transduction mediated by the insulin receptor substrate family. Endocr J 1999; 56(suppl): 25-34.

  51. Tanaka S, Mohr L, Schmidt EV, et al. Biologic effect of human insulin receptor substrat-1 overexpression in hepatocytes. Hepatology 1997; 26: 598-604.

  52. Hu W, Feng Z, Eveleigh J, et al. The major lipid peroxidation product, trans-4-hydroxy-2-noneal, preferentially from DNA adduct at codon 249 of human p53gene, a unique mutational hotspot in hepatocellular carcinoma. Carcinogenesis 2002; 23: 1781-89.

  53. Hsu HC, Peng SY, Lai PL, et al. Allotype loss of heterogeneity of p53 in primary and recurrent hepatocellular carcinoma: a stuffy of 150 patient. Cancer 1994; 73: 42-7.

  54. Balkau B, Kahn HS, Courbon D, et al. Hyperinsulinemia predicts fatal liver cancer but is inversely associated with fatal cancer at some other sites. Diabetes Care 2001; 24: 843-849.

  55. Saito K, Inoue S, Saito T, et al. Augmentation effect of postprandial hyperinsulinemia on growth of human hepatocellular carcinoma. Gut 2002; 51: 100-104.




2020     |     www.medigraphic.com