Abstract
Epidemiological data indicate that type 2 diabetes is associated with increased risk of hepatocellular carcinoma (HCC). However, risk stratification for HCC has not been fully elucidated in diabetic population. The aim of this study was to identify potential predictors of HCC in diabetic patients without chronic viral hepatitis. A cohort of 3,544 diabetic patients without chronic viral hepatitis or alcoholic cirrhosis was established and subjects were randomly allocated into a derivation and a validation set. A scoring system was developed by using potential predictors of increased risk of HCC from the Cox proportional hazards model. The performance of the scoring system was tested for validation by using receiver operating characteristics analysis. During median follow-up of 55 months, 36 cases of HCC developed (190 per 100,000 person-years). The 5- and 10-year cumulative incidences of HCC were 1.0%, and 2.2%, respectively. Multivariate Cox regression analysis showed that age > 65 years, low triglyceride levels and high gamma-glutamyl transferase levels were independently associated with an increased risk of HCC. DM-HCC risk score, a weighted sum of scores from these 3 parameters, predicted 10-year development of HCC with area under the receiver operating characteristics curve of 0.86, and discriminated different risk categories for HCC in the derivation and validation cohort. In conclusion, old age, low triglyceride level and high gamma-glutamyl transferase level may help to identify individuals at high risk of developing HCC in diabetic patients without chronic viral hepatitis or alcoholic cirrhosis.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide, with more than 700,000 new cases annually [1]
After excluding patients with chronic viral hepatitis, alcoholic cirrhosis, HCC before 12 months of follow-up and incomplete laboratory date, 3,544 patients were included in the final analysis (Fig 1)
Accumulating evidence indicates that diabetic patients are at higher risk of HCC
Summary
Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide, with more than 700,000 new cases annually [1]. The mortality of HCC is high, ranking third as a cause of cancer-related death [1]. To ensure early diagnosis and reduce HCC-related mortality, surveillance program has been advocated in populations at an increased risk of HCC [2, 3]. Liver cirrhosis and chronic viral hepatitis are well-known risk factors for HCC [2, 4], and surveillance for HCC has been recommended in these conditions [2, 5]. PLOS ONE | DOI:10.1371/journal.pone.0158066 June 30, 2016
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