Journal of Gastroenterology

, Volume 50, Issue 3, pp 333–341

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
Original Article—Liver, Pancreas, and Biliary Tract

DOI: 10.1007/s00535-014-0968-5

Cite this article as:
Kawaguchi, T., Kohjima, M., Ichikawa, T. et al. J Gastroenterol (2015) 50: 333. doi:10.1007/s00535-014-0968-5

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.

Keywords

Diabetes mellitus Chronic liver disease Morbidity Risk factor 

Abbreviations

HCC

Hepatocellular carcinoma

CLD

Chronic liver disease

DPP-4

Dipeptidyl peptidase-4

AST

Aspartate aminotransferase

APRI

AST to platelet ratio index

ALT

Alanine aminotransferase

GGT

Gamma-glutamyl transpeptidase

HbA1c

Hemoglobin A1c

HCV

Hepatitis C virus

HBV

Hepatitis B virus

MAPK

Mitogen-activated protein kinase

IGF

Insulin-like growth factor

Supplementary material

535_2014_968_MOESM1_ESM.pptx (449 kb)
Supplementary material 1 (PPTX 448 kb)
535_2014_968_MOESM2_ESM.docx (37 kb)
Supplementary material 2 (DOCX 37 kb)

Copyright information

© Springer Japan 2014

Authors and Affiliations

  • Takumi Kawaguchi
    • 1
  • Motoyuki Kohjima
    • 2
  • Tatsuki Ichikawa
    • 3
  • Masataka Seike
    • 4
  • Yasushi Ide
    • 5
  • Toshihiko Mizuta
    • 5
  • Koichi Honda
    • 4
  • Kazuhiko Nakao
    • 3
  • Makoto Nakamuta
    • 2
  • Michio Sata
    • 1
  1. 1.Division of Gastroenterology, Department of Medicine and Department of Digestive Disease Information & ResearchKurume University School of MedicineKurumeJapan
  2. 2.Department of GastroenterologyKyushu Medical CenterFukuokaJapan
  3. 3.Department of Gastroenterology and HepatologyNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
  4. 4.Department of Gastroenterology, Faculty of MedicineOita UniversityYuhuJapan
  5. 5.Division of Hepatology, Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Faculty of Medicine, Saga Medical SchoolSaga UniversitySagaJapan

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