Diabetes increases risk for hepatocarcinogenesis in patients with hepatitis C
MedWire News: Diabetes increases the risk for hepatocellular carcinoma in patients with noncirrhotic, interferon-treated hepatitis C, show study results.
However, the researchers found that patients who had an interferon-induced sustained virologic response were significantly less likely to develop cancer than those with a nonsustained response, independent of diabetes status.
Hepatocellular carcinoma occurs in around 5-10% of all patients with hepatitis C and is one of the main causes of death from the condition. Evidence suggests that individuals with diabetes who become infected with hepatitis C may be at increased risk for this outcome.
To investigate further, Yusuke Kawamura (Toranomon Hospital, Tokyo, Japan) and colleagues recruited 2058 hepatitis C infected, noncirrhotic patients who were being treated with interferon, 104 of whom had diabetes. They were followed up for a median of 6.7 years for incidence of hepatocellular carcinoma.
The researchers found that cumulative rates of hepatocellular carcinoma in diabetic patients were 3.2%, 8.5%, and 24.4% at 4, 8, and 12 years, respectively. The corresponding rates in nondiabetics were significantly lower, at 1.3%, 2.2%, and 5.6%.
Of note, presence of diabetes appeared to have no effect on patients who had a sustained, as opposed to a nonsustained, virologic response to interferon therapy. In the 977 patients with a nonsustained response, 5.2% of the nondiabetic and 19.7% of the diabetic patients developed hepatocellular carcinoma, as opposed to a respective 1.0% and 3.0% of the 1081 patients with a sustained response.
Results from multivariate analysis demonstrated that lack of a sustained virologic response to interferon and presence of diabetes increased the relative risk for hepatocellular carcinoma a significant 7.28- and 2.00-fold, respectively.
"Diabetes is an independent predictor of several types of cancers, including hepatocellular carcinoma in patients with or without viral infection," say Kawamura et al.
"Our results indicate that a sustained virologic response induced by interferon therapy eliminates the influence of diabetes mellitus and markedly reduces the rate of hepatocarcinogenesis in noncirrhotic, interferon-treated, hepatitis C virus-positive patients," they conclude in the American Journal of Medicine.
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By Helen Albert