Association between Type 2 Diabetes and Hepatocelluar Carcinoma in High Prevalence of Hepatitis B or C Infection: A Prospective Cohort from KCIS Study

Background: The association between diabetes mellitus (DM) and primary hepatocellular carcinoma (HCC) in western countries had been corroborated. But the relation in countries with high prevalence of hepatitis should be examined. The possible effect modification or interaction between DM and other risk factors still need to be explored.
Method: A prospective cohort with 54,929 subjects from the Keelung Community-based Integrated Screening (KCIS) was followed from 1999 to 2003. HCC was ascertained by two-stage liver screen and National Cancer Registry linkage. Risk factors were measured by blood sampling and questionnaire.
Results: 138 HCC cases were identified. The effect of type 2 DM on HCC was not statistically significant after controlling age, gender, HBV and HCV that were strong risk factors. HCV (P=0.04) and hypercholesterolemia (P=0.03) were two significant effect modifiers. But the synergy index was significant only in crude odds ratio for interaction between DM and hypercholesterolemia. Stratifications which diabetes significantly increases the risk of HCC are patients without hepatitis C (adjusted odds ratio=1.98) and patients with hypercholesterolemia (adjusted odds ratio=2.52)
Conclusion: Different form previous studies in the low HCC prevalence areas, diabetes mellitus does not play an independent role in the development of HCC in Taiwan after adjusting major risk factors. The association between DM and liver cancer was influenced or modified by hepatitis C and total cholesterol. The effect of DM for HCC is significant in the absence of hepatitis C infection and in the presence of hypercholesterolemia.