The morbidity and associated risk factors of cancer in chronic liver disease patients with diabetes mellitus

a multicenter field survey

Takumi Kawaguchi, Motoyuki Kohjima, Tatsuki Ichikawa, Masataka Seike, Yasushi Ide, Toshihiko Mizuta, Koichi Honda, Kazuhiko Nakao, Makoto Nakamuta, Michio Sata

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background and aims: Diabetes mellitus is associated with various cancers; however, little is known of the relationship between cancer and diabetes in chronic liver disease (CLD) patients. The aim of this study is to investigate the morbidity and associated factors of cancer, including the use of anti-diabetics, in CLD patients with diabetes.

Patients and methods: We performed a multicenter survey in 2012 and 478 CLD patients with diabetes were enrolled (age 64.3 ± 12.1 years, female/male 187/291). A frequency analysis of cancer and antidiabetic use was performed. Independent factors for cancer were analyzed using logistic regression and decision-tree analysis.

Results: The morbidity of cancer was 33.3 %. Hepatocellular carcinoma (HCC) and extra-hepatic cancer were diagnosed in 24.7 and 11.3 % of enrolled patients, respectively. The frequency of antidiabetic use was 66.5 %. Of prescribed antidiabetics, 39 % were dipeptidyl-peptidase 4 inhibitors; however, their use was not significantly associated with cancer. In contrast, the use of exogenous insulin (OR 2.21; 95 % CI 1.16–4.21, P = 0.0165) and sulfonylurea (OR 2.08; 95 % CI 1.05–3.97, P = 0.0353) were independently associated with HCC and extra-hepatic cancer, respectively. In decision-tree analysis, exogenous insulin and sulfonylurea were also identified as a divergence factor for HCC and extra-hepatic cancer, respectively.

Conclusions: We found a high morbidity of not only HCC, but also extra-hepatic cancer in CLD patients with diabetes. We also showed a possible association between the use of antidiabetics and the morbidity of cancer. Thus, a large-scale cohort study is needed to establish a therapeutic strategy for diabetes to suppress carcinogenesis in CLD patients.

Original languageEnglish
Pages (from-to)333-341
Number of pages9
JournalJournal of Gastroenterology
Volume50
Issue number3
DOIs
Publication statusPublished - Jan 1 2015
Externally publishedYes

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Liver Diseases
Diabetes Mellitus
Chronic Disease
Morbidity
Liver Neoplasms
Hypoglycemic Agents
Hepatocellular Carcinoma
Neoplasms
Decision Trees
Decision Support Techniques
Insulin
Dipeptidyl-Peptidase IV Inhibitors
Surveys and Questionnaires
neoplasm-associated factor
Carcinogenesis
Cohort Studies
Logistic Models

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

The morbidity and associated risk factors of cancer in chronic liver disease patients with diabetes mellitus : a multicenter field survey. / Kawaguchi, Takumi; Kohjima, Motoyuki; Ichikawa, Tatsuki; Seike, Masataka; Ide, Yasushi; Mizuta, Toshihiko; Honda, Koichi; Nakao, Kazuhiko; Nakamuta, Makoto; Sata, Michio.

In: Journal of Gastroenterology, Vol. 50, No. 3, 01.01.2015, p. 333-341.

Research output: Contribution to journalArticle

Kawaguchi, Takumi ; Kohjima, Motoyuki ; Ichikawa, Tatsuki ; Seike, Masataka ; Ide, Yasushi ; Mizuta, Toshihiko ; Honda, Koichi ; Nakao, Kazuhiko ; Nakamuta, Makoto ; Sata, Michio. / The morbidity and associated risk factors of cancer in chronic liver disease patients with diabetes mellitus : a multicenter field survey. In: Journal of Gastroenterology. 2015 ; Vol. 50, No. 3. pp. 333-341.
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abstract = "Background and aims: Diabetes mellitus is associated with various cancers; however, little is known of the relationship between cancer and diabetes in chronic liver disease (CLD) patients. The aim of this study is to investigate the morbidity and associated factors of cancer, including the use of anti-diabetics, in CLD patients with diabetes.Patients and methods: We performed a multicenter survey in 2012 and 478 CLD patients with diabetes were enrolled (age 64.3 ± 12.1 years, female/male 187/291). A frequency analysis of cancer and antidiabetic use was performed. Independent factors for cancer were analyzed using logistic regression and decision-tree analysis.Results: The morbidity of cancer was 33.3 {\%}. Hepatocellular carcinoma (HCC) and extra-hepatic cancer were diagnosed in 24.7 and 11.3 {\%} of enrolled patients, respectively. The frequency of antidiabetic use was 66.5 {\%}. Of prescribed antidiabetics, 39 {\%} were dipeptidyl-peptidase 4 inhibitors; however, their use was not significantly associated with cancer. In contrast, the use of exogenous insulin (OR 2.21; 95 {\%} CI 1.16–4.21, P = 0.0165) and sulfonylurea (OR 2.08; 95 {\%} CI 1.05–3.97, P = 0.0353) were independently associated with HCC and extra-hepatic cancer, respectively. In decision-tree analysis, exogenous insulin and sulfonylurea were also identified as a divergence factor for HCC and extra-hepatic cancer, respectively.Conclusions: We found a high morbidity of not only HCC, but also extra-hepatic cancer in CLD patients with diabetes. We also showed a possible association between the use of antidiabetics and the morbidity of cancer. Thus, a large-scale cohort study is needed to establish a therapeutic strategy for diabetes to suppress carcinogenesis in CLD patients.",
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T1 - The morbidity and associated risk factors of cancer in chronic liver disease patients with diabetes mellitus

T2 - a multicenter field survey

AU - Kawaguchi, Takumi

AU - Kohjima, Motoyuki

AU - Ichikawa, Tatsuki

AU - Seike, Masataka

AU - Ide, Yasushi

AU - Mizuta, Toshihiko

AU - Honda, Koichi

AU - Nakao, Kazuhiko

AU - Nakamuta, Makoto

AU - Sata, Michio

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N2 - Background and aims: Diabetes mellitus is associated with various cancers; however, little is known of the relationship between cancer and diabetes in chronic liver disease (CLD) patients. The aim of this study is to investigate the morbidity and associated factors of cancer, including the use of anti-diabetics, in CLD patients with diabetes.Patients and methods: We performed a multicenter survey in 2012 and 478 CLD patients with diabetes were enrolled (age 64.3 ± 12.1 years, female/male 187/291). A frequency analysis of cancer and antidiabetic use was performed. Independent factors for cancer were analyzed using logistic regression and decision-tree analysis.Results: The morbidity of cancer was 33.3 %. Hepatocellular carcinoma (HCC) and extra-hepatic cancer were diagnosed in 24.7 and 11.3 % of enrolled patients, respectively. The frequency of antidiabetic use was 66.5 %. Of prescribed antidiabetics, 39 % were dipeptidyl-peptidase 4 inhibitors; however, their use was not significantly associated with cancer. In contrast, the use of exogenous insulin (OR 2.21; 95 % CI 1.16–4.21, P = 0.0165) and sulfonylurea (OR 2.08; 95 % CI 1.05–3.97, P = 0.0353) were independently associated with HCC and extra-hepatic cancer, respectively. In decision-tree analysis, exogenous insulin and sulfonylurea were also identified as a divergence factor for HCC and extra-hepatic cancer, respectively.Conclusions: We found a high morbidity of not only HCC, but also extra-hepatic cancer in CLD patients with diabetes. We also showed a possible association between the use of antidiabetics and the morbidity of cancer. Thus, a large-scale cohort study is needed to establish a therapeutic strategy for diabetes to suppress carcinogenesis in CLD patients.

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