Metabolic Factors and Risk of Hepatocellular Carcinoma by Chronic Hepatitis B/C Infection: A Follow-up Study in Taiwan

Chen, Chi‐Ling; Yang, Hwai‐I; Yang, Wei–Shiung; Liu, Chun‐Jen; Chen, Pei‐Jer; You, San–Lin; Wang, Li‐Yu; Sun, Chien‐An; Lu, Sheng–Nan; Chen, Ding‐Shinn; Chen, Chien‐Jen

doi:10.1053/j.gastro.2008.03.073

Cited by 497 publications

(434 citation statements)

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“…In this study, HBV infection, which is more common in males (11,12), was lower in the elderly group than in the younger group. Moreover, males were more likely to be heavy drinkers.…”

Section: Discussionmentioning

confidence: 43%

Clinical characteristics of hepatocellular carcinoma in elderly patients

Miyaaki

2011

Oncol Lett

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Abstract. The incidence of hepatocellular carcinoma (HCC) in elderly patients in Japan has been on the increase. The aim of the present study was to evaluate the impact of aging on the clinicopathological findings and the survival of HCC patients. A total of 624 patients with HCC were examined in this study. The patients were classified according to their age at the time of diagnosis: one group comprised younger patients (<75 years; n=544) and the second comprised elderly patients [(≥75 years; n=80, (12%)]. Results showed that there were significantly more female patients (younger:elderly, 22:36; p= 0.005), normal livers (younger:elderly, 0.3:6%; p= 0.0002), non-viral HCC (younger:elderly, 11:31%; p<0.001) and solitary tumors (younger:elderly, 53:76%; p= 0.0008) in the elderly group. Five out of seven (71%) non-B non-C (NBNC) HCC patients who developed HCC in the normal liver were elderly patients. Survival between the younger and elderly HCC groups was not significantly different (younger:elderly, 4.38:3.45 years; p= 0.665). Additionally, elderly HCC patients had fewer tumors, more mild underlying liver damage, and more frequent NBNC HCC. Their prognosis was not necessarily poorer than that of the younger HCC patients. Additionally, it appears that elderly patients develop HCC even without fibrosis. Therefore, aging may be a factor affecting hepatocarcinogenesis. IntroductionHepatocellular carcinoma (HCC) is one of the most common cancers (1,2), with an estimated half a million cases annually, worldwide. Although HCC is generally diagnosed in middleaged and elderly individuals, the age distribution of HCC varies according to etiology. The differences in age at the time of diagnosis of HCC affect the treatment strategy.The Japanese population has one of the longest average life spans, and the size of the aged population has been increasing rapidly. As a result, the prevalence of elderly patients with HCC has increased (3-5). There is some controversy regarding whether aging plays a role in the factors and survival of patients with HCC. Previous studies reported that the longterm survival of younger HCC patients is similar to that of elderly patients (6,7). On the other hand, it has been reported that elderly HCC patients tended to have a poorer prognosis (8).A recent increase in the number of elderly HCC patients in Japan has been reported (4,9,10). However, the impact of aging on the emergence of HCC has yet to be adequately investigated. Therefore, the aim of the present study was to investigate the effect of aging on the clinicopathological findings and the survival of HCC patients. Patients and methods Patients.A total of 624 patients presenting with HCC at the Department of Gastroenterology and Hepatology, Nagasaki University School of Medicine, Japan, were recruited for this study, between October 1981 and October 2007. The diagnosis of HCC was based on α-fetoprotein (AFP) levels, des-γ-carboxy prothrombin (DCP) levels, imaging studies including ultrasonography (USG), computerized tomography (CT), magnetic...

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“…In this study, HBV infection, which is more common in males (11,12), was lower in the elderly group than in the younger group. Moreover, males were more likely to be heavy drinkers.…”

Section: Discussionmentioning

confidence: 43%

Clinical characteristics of hepatocellular carcinoma in elderly patients

Miyaaki

2011

Oncol Lett

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“…A synergistic relationship has also been reported to exist between diabetes and other known risk factors for HCC, specifi cally viral hepatitis and alcohol use ( 11,17 ). A recent study reported that among HCV-infected patients who were not infected with HBV, those with diabetes had a 3.5-fold increased risk of developing HCC compared with those without diabetes ( 17 ).…”

Section: Th E Incidence Of Hepatocellular Carcinoma (Hcc) In the Unitedmentioning

confidence: 99%

“…A recent study reported that among HCV-infected patients who were not infected with HBV, those with diabetes had a 3.5-fold increased risk of developing HCC compared with those without diabetes ( 17 ). Th e same study found a lower yet signifi cant increase in the risk of HCC among patients with HBV who were not infected with HCV among those with diabetes compared to those without diabetes (relative risk = 2.17; 95 % CI: 1.07 -4.43).…”

Section: Th E Incidence Of Hepatocellular Carcinoma (Hcc) In the Unitedmentioning

confidence: 99%

“…One study of over 19,000 patients found that the incidence of HCC was higher in obese (defi ned as BMI > 30 kg / m 2 ) patients than in nonobese patients (4.0 % vs. 3.0 % , respectively; P = 0.013), and that obesity was associated with a 65 % increased risk of developing HCC ( 13 ). Another large prospective cohort study of more than 900,000 individuals reported that the mortality rate from liver cancer was fi ve times greater among those with a BMI between 35 -40 compared with those with a normal BMI ( 5 ).A synergistic relationship has also been reported to exist between diabetes and other known risk factors for HCC, specifi cally viral hepatitis and alcohol use ( 11,17 ). A recent study reported that among HCV-infected patients who were not infected with HBV, those with diabetes had a 3.5-fold increased risk of developing HCC compared with those without diabetes ( 17 ).…”

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confidence: 99%

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Diabetes and Hepatocellular Carcinoma: What Role Does Diabetes Have in the Presence of Other Known Risk Factors?

Davila

2010

American Journal of Gastroenterology

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Known risk factors for hepatocellular carcinoma (HCC) include hepatitis C, hepatitis B, and alcoholic liver disease. Several studies have examined diabetes as a risk factor for HCC because of its association with fatty liver disease and nonalcoholic steatohepatitis. The current study by Tung et al. found that neither diabetes nor overweight was a risk factor for HCC. Results were consistent using both a cross-sectional and a case -control study approach. Findings from this study suggest that diabetes and overweight alone are not adequate to increase the risk of HCC in the absence of concomitant viral hepatitis or liver disease. Am J Gastroenterol 2010; 105:632 -634; doi: 10.1038/ajg.2009 Th e incidence of hepatocellular carcinoma (HCC) in the United States has more than doubled over the past two decades ( 1 ). Primary known risk factors for HCC are hepatitis C virus (HCV), hepatitis B virus (HBV), and alcoholic liver disease ( 2,3 ). Yet previous studies have reported the absence of these risk factors in up to 50 % of HCC cases ( 4 ). Other potential risk factors for HCC include diabetes and obesity as measured by body mass index (BMI). Th e proposed mechanism of HCC development for diabetes and obesity is through the development of fatty liver disease and non-alcoholic steatohepatitis (NASH). Th e pathogenesis of NASH involves insulin resistance, which is associated with both obesity and diabetes ( 5 ). Several studies have examined the association between HCC and diabetes. Earlier studies reported no association between diabetes and HCC, while more recent studies have identifi ed diabetes as a risk factor for HCC ( 6 -15 ). A study conducted among a large cohort of Veterans found that the incidence of HCC was increased more than twofold among patients with diabetes, and that the risk of developing HCC among patients with diabetes was 2.2 times greater than in patients without diabetes ( 9 ). Another population-based case -control study using the Surveillance, Epidemiology and End Results Medicare database reported an odds ratio of 2.87 (95 % confi dence interval (CI): 2.49 -3.30) for diabetes among patients without other major risk factors (HCV, HBV, alcoholic liver disease, or hemochromatosis) for HCC ( 7 ).Other studies have focused on the association between HCC and obesity. It is estimated that 90 % of people with obesity have fatty liver disease, including NASH and cirrhosis ( 16 ). One study of over 19,000 patients found that the incidence of HCC was higher in obese (defi ned as BMI > 30 kg / m 2 ) patients than in nonobese patients (4.0 % vs. 3.0 % , respectively; P = 0.013), and that obesity was associated with a 65 % increased risk of developing HCC ( 13 ). Another large prospective cohort study of more than 900,000 individuals reported that the mortality rate from liver cancer was fi ve times greater among those with a BMI between 35 -40 compared with those with a normal BMI ( 5 ).A synergistic relationship has also been reported to exist between diabetes and other known risk factors for HC...

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“…In addition, the accompanying metabolic derangements, cardiovascular diseases [2], non-alcoholic fatty liver disease [3], and different malignant diseases also heavily impact public health and economic burden worldwide. Insulin resistance, the essence of metabolic syndrome with a constellation of metabolic derangements as well as risk factors for both cardiovascular diseases and diabetes [2], is known to aggravate hepatic steatosis, drive liver fibrosis progression, and increase the risk of hepatocellular carcinoma (HCC) [4]. Therefore, metabolic factors and their adjustments have been increasingly recognized in the clinical practice of hepatology, and become hot subjects in this active research field [5].…”

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confidence: 99%