Brief Article
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World J Gastroenterol. Sep 21, 2010; 16(35): 4467-4475
Published online Sep 21, 2010. doi: 10.3748/wjg.v16.i35.4467
Diabetes mellitus and hepatocellular carcinoma: Comparison of Chinese patients with and without HBV-related cirrhosis
Chun Gao, Hong-Chuan Zhao, Jing-Tao Li, Shu-Kun Yao
Chun Gao, Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
Chun Gao, Hong-Chuan Zhao, Jing-Tao Li, Shu-Kun Yao, Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, Beijing 100029, China
Author contributions: Gao C conceived the study and participated in the study design, acquisition of data, statistical analysis and manuscript writing; Zhao HC participated in the study design and critically revised the manuscript for important intellectual content; Li JT participated in the study design and acquisition of data; Yao SK participated in the study design and coordination, the acquisition of data and statistical analysis and critically revised the manuscript for important intellectual content; all authors have read and approved the final manuscript.
Supported by Grant No. 30772859 from the National Natural Science Foundation of China
Correspondence to: Dr. Shu-Kun Yao, MD, Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, No. 2 Yinghua East Road, Beijing 100029, China. yaosk@zryhyy.com.cn
Telephone: +86-10-84206160 Fax: +86-10-64222978
Received: June 8, 2010
Revised: June 28, 2010
Accepted: July 5, 2010
Published online: September 21, 2010
Abstract

AIM: To determine the role of diabetes mellitus (DM) and other associated factors in Chinese hepatocellular carcinoma (HCC) patients with cirrhosis, compared with those HCC patients without cirrhosis, in the single setting of hepatitis B virus (HBV) infection, after other known concomitant diseases were excluded.

METHODS: A total of 482 patients, treated at the China-Japan Friendship Hospital, Ministry of Health (Beijing, China), in the period January 2003 to June 2009, and with a hospital discharge diagnosis of HCC, were included. Demographic, clinical, laboratory, metabolic and instrumental features were analyzed.

RESULTS: Of the total, 310 patients were diagnosed with HBV infection and, following the inclusion and exclusion criteria, 224 were analyzed, including 122 patients (54.5%) with cirrhosis (the case group) and 102 patients without cirrhosis (the control group). Twenty-seven patients (12.1%) were diabetic, including 19 in the case group and 8 in the control group (19/122 = 15.6% vs 8/102 = 7.8%, P = 0.077). Thirty-one possible relevant parameters were compared by univariate analysis, and 9 variables were selected for multivariable analysis, including DM (P = 0.077), past history of HBV infection (P = 0.005), total bilirubin (P < 0.001), albumin level (P < 0.001), international normalized ratio (INR) (P < 0.001), alanine aminotransferase (P = 0.050), platelet (P < 0.001), total cholesterol (P = 0.047), and LDL cholesterol (P = 0.002) levels. Diabetes showed a statistical difference by multivariable analysis [odds ratio (OR) 4.88, 95% confidence interval (CI): 1.08-21.99, P = 0.039], although no significant difference was found in univariate analysis. In addition, three cirrhosis-related parameters remained statistically different, including INR (OR 117.14, 95% CI: 4.19-3272.28, P = 0.005), albumin (OR 0.89, 95% CI: 0.80-0.99, P = 0.027), and platelet count (OR 0.992, 95% CI: 0.987-0.999, P = 0.002).

CONCLUSION: Besides the three cirrhosis-related parameters, DM was found to be the sole independent factor associated with HCC in patients with HBV-related cirrhosis, compared with those without cirrhosis.

Keywords: Diabetes mellitus, Hepatocellular carcinoma, Hepatitis B virus, Cirrhosis, Chinese patients