Diabetes linked to elevated HCC risk after HBsAg seroclearance
medwireNews: Diabetes remains an independent risk factor for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection even after hepatitis B surface antigen (HBsAg) seroclearance, findings indicate.
But glycemic control appears to mitigate this risk, the researchers from The Chinese University of Hong Kong say in Clinical Gastroenterology and Hepatology.
They explain that diabetes has been shown to be associated with a twofold increased HCC risk among chronic HBV patients, but it is not clear what role diabetes plays once individuals achieve HBsAg seroclearance, which is considered “a surrogate of ultimate immune control” in these patients.
The team drew on the Clinical Data Analysis and Reporting System of the Hospital Authority, Hong Kong, to identify 4568 patients who cleared HBsAg between 2000 and 2016. Of these, just over a third (34.2%) had diabetes, defined on the basis of the International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, glycated hemoglobin (HbA1c) levels of at least 6.5%, fasting glucose levels of 7 mmol/L or more, and/or exposure to any antidiabetic agent.
During a median follow-up of 3.4 years, 1.9% of chronic HBV patients with diabetes developed HCC, as did 0.8% of those without diabetes.
Among participants with diabetes, the cumulative incidence of HCC was 1.1% at 1 year after HBsAg seroclearance , rising to 2.1% at 3 years and 2.6% at 5 years. The corresponding rates for nondiabetic participants were 0.8%, 0.9%, and 0.9%, with the between-group differences reaching significance (p=0.001).
And in multivariate analysis accounting for factors such as age, male sex, and presence of cirrhosis, diabetes was an independent and significant risk factor for HCC, at a hazard ratio of 1.85.
Grace Lai-Hung Wong and co-authors also found that suboptimal glycemic control over time was linked to an increased HCC risk. Specifically, after adjusting for variables including age at HBsAg seroclearance and statin use, a time-weighted average HbA1c of 7.0% or more versus below 6.5% was a significant predictor of HCC risk (HR=3.71, p=0.011), whereas time-weighted mean HbA1c levels of at least 6.5% but less than 7.0% were not.
In the same analysis, use of oral hypoglycemic agents was associated with a significantly reduced risk for HCC (p=0.005).
The study authors therefore suggest that “[p]revention of [diabetes] and good diabetic control may further reduce the risk of HCC in this population.”
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