NASH: comorbid DM is tied to excess risk for liver cancer

  • Yang JD & al.
  • Hepatology
  • 15 Jul 2019

  • International Clinical Digest
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Takeaway

  • Diabetes mellitus (DM) is associated with an excess risk for hepatocellular carcinoma (HCC) in patients with nonalcoholic steatohepatitis (NASH) cirrhosis.  

Why this matters

  • Diabetes was previously linked to an increased risk for cirrhosis in NASH.
  • Older people with diabetes and low serum albumin should be carefully monitored for HCC.

Study design

  • Study of 354 Mayo Clinic patients (41% male; 94% white; mean age, 61.5 years) with NASH cirrhosis, externally validated by a national registry cohort of 6630 liver transplant recipients.
  • Funding: National Cancer Institute.

Key results

  • Mayo Clinic: 71% of patients with NASH cirrhosis had diabetes.
  • In median 47-month follow-up, 30 patients developed HCC; 27 had diabetes.
    • 5-year cumulative incidence was higher with comorbid diabetes (10.2% vs 1.7%).
  • Diabetes was tied to increased risk for HCC in univariate (HR, 3.62; P=.04) and multivariate analyses (HR, 4.18; P=.02).
  • Other HCC risk factors: age (per decade: HR, 1.75; P=.008), low serum albumin (HR, 2.1; P<.01>
  • Registry data: 58% of liver transplant recipients had diabetes.
    • 291 developed HCC, including 191 with diabetes.
    • 5-year cumulative rate was higher with diabetes (6.3% vs 4.6%).
  • Registry data confirmed link of diabetes and increased risk for HCC in univariate (HR, 1.41; P=.005) and multivariate analyses (HR, 1.30; P=.03).

Limitations

  • Retrospective.
  • Reliance on ICD-9 codes.