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World J Gastroenterol. Oct 7, 2008; 14(37): 5695-5700
Published online Oct 7, 2008. doi: 10.3748/wjg.14.5695
Association between hepatocellular carcinoma and type 2 diabetes mellitus in Italy: Potential role of insulin
Valter Donadon, Massimiliano Balbi, Pietro Casarin, Alessandro Vario, Alfredo Alberti
Valter Donadon, Massimiliano Balbi, Pietro Casarin, Alessandro Vario, Department of Medicine and Internal Medicine 3rd, Pordenone Hospital, Pordenone 33170, Italy
Alfredo Alberti, Department of Clinical and Experimental Medicine, University of Padova, Padova 35100, Italy
Author contributions: Donadon V conceived and designed research; Balbi M, Casarin P, Donadon V performed research, diagnosis and patient follow-up, Vario A analyzed the data; Donadon V, Alberti A wrote the paper; Alberti A revised the paper.
Correspondence to: Dr. Valter Donadon, Internal Medicine 3rd, Pordenone Hospital, Via Montereale 24, Pordenone 33170, Italy. valter.donadon@aopn.fvg.it
Telephone: +39-434-399330 Fax: +39-434-399559
Received: July 29, 2008
Revised: September 1, 2008
Accepted: September 8, 2008
Published online: October 7, 2008
Abstract

AIM: To investigate the relationships between Type 2 diabetes mellitus (DM2) and the risk of hepatocellular carcinoma (HCC).

METHODS: We studied the association between DM2 and HCC in a large case-control study that enrolled 465 consecutive Caucasian patients with HCC (78.3% males, mean age 68.5 ± 8.9 years) compared with an age and sex matched control group of 490 subjects.

RESULTS: Prevalence of DM2 was significantly higher in HCC patients (31.2% vs 12.7%; OR = 3.12, 95% CI: 2.22-4.43) and in HCC cases with alcohol abuse. DM2 has been diagnosed before the appearance of HCC in 84.1% of diabetic HCC subjects with mean duration of 141.5 mo, higher in cases treated with insulin than in those with oral antidiabetic agents (171.5 vs 118.7 mo). Compared to controls, males DM2 with HCC were more frequently treated with insulin (38.1% vs 17.6%, P = 0.009) and with sulfonylurea with or without metformin than with diet with or without metformin (84% vs 68.3%, P = 0.049).

CONCLUSION: DM2 in our patients is associated with a 3-fold increase risk of HCC. In most of our cases DM2 pre-existed to HCC. Patients with DM2 and chronic liver disease, particularly insulin treated males, should be considered for HCC close surveillance programs.

Keywords: Hepatocellular carcinoma; Type 2 diabetes mellitus; Hepatitis virus B and C; Insulin; Antidiabetic therapy