NEW YORK (Reuters Health) Mar 07 - It appears that diabetes is an independent risk factor for hepatocellular carcinoma (HCC), raising the risk two- to three-fold, investigators report in the April issue of Gut.

While previous studies have revealed a relationship between diabetes and HCC (see Reuters Health reports, February 25 and September 7, 2004), results were based on referral samples and selection bias may have occurred.

The current study, using data from the Surveillance, Epidemiology, and End-Results (SEER)-Medicare database, is the first population-based case-control study in the US that adjusted for other major risk factors related to HCC, senior author Dr. Hashem El-Serag, at Baylor College of Medicine in Houston, and colleagues maintain.

The study included 2161 patients aged 65 and older with diagnostic confirmation of HCC between 1994 and 1999. The control group included 6183 randomly selected individuals.

The authors found that 43.3% of HCC patients and 19.4% of control subjects had diabetes diagnosed during the 3 years preceding the date of HCC diagnosis (to exclude the possibility that HCC was the cause of the diabetes).

After adjusting for demographic factors, the odds ratio of HCC associated with diabetes was 3.08 (p < 0.0001). After excluding patients with hepatitis B or C virus, alcoholic liver disease or hemochromatosis, the odds ratio remained 2.87 to 3.11.

Hepatitis C virus alone was associated with an odds ratio of 24.42. In the presence of diabetes, it was increased to 36.88, suggesting a synergistic interaction between the two diseases.

"Diabetes may account for a significant proportion of patients with idiopathic HCC," Dr. El-Serag's group concludes.

Gut 2005;54:533-539.

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