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The morbidity and associated risk factors of cancer in chronic liver disease patients with diabetes mellitus: a multicenter field survey

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Abstract

Background and aims

Diabetes mellitus is associated with various cancers; however, little is known of the relationship between cancer and diabetes in chronic liver disease (CLD) patients. The aim of this study is to investigate the morbidity and associated factors of cancer, including the use of anti-diabetics, in CLD patients with diabetes.

Patients and methods

We performed a multicenter survey in 2012 and 478 CLD patients with diabetes were enrolled (age 64.3 ± 12.1 years, female/male 187/291). A frequency analysis of cancer and antidiabetic use was performed. Independent factors for cancer were analyzed using logistic regression and decision-tree analysis.

Results

The morbidity of cancer was 33.3 %. Hepatocellular carcinoma (HCC) and extra-hepatic cancer were diagnosed in 24.7 and 11.3 % of enrolled patients, respectively. The frequency of antidiabetic use was 66.5 %. Of prescribed antidiabetics, 39 % were dipeptidyl-peptidase 4 inhibitors; however, their use was not significantly associated with cancer. In contrast, the use of exogenous insulin (OR 2.21; 95 % CI 1.16–4.21, P = 0.0165) and sulfonylurea (OR 2.08; 95 % CI 1.05–3.97, P = 0.0353) were independently associated with HCC and extra-hepatic cancer, respectively. In decision-tree analysis, exogenous insulin and sulfonylurea were also identified as a divergence factor for HCC and extra-hepatic cancer, respectively.

Conclusions

We found a high morbidity of not only HCC, but also extra-hepatic cancer in CLD patients with diabetes. We also showed a possible association between the use of antidiabetics and the morbidity of cancer. Thus, a large-scale cohort study is needed to establish a therapeutic strategy for diabetes to suppress carcinogenesis in CLD patients.

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Abbreviations

HCC:

Hepatocellular carcinoma

CLD:

Chronic liver disease

DPP-4:

Dipeptidyl peptidase-4

AST:

Aspartate aminotransferase

APRI:

AST to platelet ratio index

ALT:

Alanine aminotransferase

GGT:

Gamma-glutamyl transpeptidase

HbA1c:

Hemoglobin A1c

HCV:

Hepatitis C virus

HBV:

Hepatitis B virus

MAPK:

Mitogen-activated protein kinase

IGF:

Insulin-like growth factor

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Correspondence to Takumi Kawaguchi.

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Kawaguchi, T., Kohjima, M., Ichikawa, T. et al. The morbidity and associated risk factors of cancer in chronic liver disease patients with diabetes mellitus: a multicenter field survey. J Gastroenterol 50, 333–341 (2015). https://doi.org/10.1007/s00535-014-0968-5

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  • DOI: https://doi.org/10.1007/s00535-014-0968-5

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