Risk of Malignant Neoplasms of Liver and Biliary Tract in Diabetic Patients With Different Age and Sex Stratifications

Abstract

We prospectively investigated 615,532 diabetic patients and 614,871 age-matched and sexmatched control subjects selected from National Health Insurance claims for malignant neoplasms of liver and biliary tract (International Statistical Classification of Diseases and Related Health Problems, 9th edition, codes 155 and 156, respectively) between 2000 and 2006. The person-year approach with Poisson assumption was used to estimate the hazard rates. We also evaluated the age-specific and sex-specific relative risks of these two malignancies in relation to diabetes with Cox proportional hazard regression model with adjustment for potential confounders. The overall hazard rate of malignant neoplasm of the liver was 32.76 and 17.41 per 10,000 patient-years, respectively, for diabetic men and women; the corresponding figures for biliary tract neoplasm were much lower at 1.42 and 1.60 per 10,000 patient-years. Compared with control subjects, diabetic patients had a two-fold increased risk of malignant neoplasm of the liver, but this risk was attenuated by adjusting for selected clinical risk factors (hazard ratio [HR] 1.21; 95% confidence interval [CI] 1.17-1.25). Additionally, diabetic patients were associated with increased risk of biliary neoplasms with an approximate magnitude of 20%-30%, but the HR was attenuated and became insignificant after adjustment for clinical risk factors (HR 1.07; 95% CI 0.95-1.21). Diabetic patients with cirrhosis had the highest relative risk of liver neoplasm (HR 85.25;), whereas those with cholangitis had the highest risk of biliary tract neoplasm (HR 70.30;) compared with control subjects without any clinical risk factors. Conclusion: This population-based study confirms the association of diabetes with liver neoplasm and suggests that diabetic patients with certain clinical risk factors should be educated for strict adherence of liver neoplasm screening. (HEPATOLOGY 2010;52:155-163)

Diabetes mellitus and increased risk of biliary tract cancer: systematic review and meta-analysis

“…These 13 cohort studies had a median duration of follow-up of 10 years (range: 2.3-20 years), reporting a total of 2,493 incident cases of BTC or cancer of its subsites. The methods of DM ascertainment were on the basis of self-reported history of DM or blood glucose levels test in most studies, except for two studies in which the ascertainment of DM was based on registry of disease [26,27]. The ascertainment of outcome was based on cancer registry in all studies, with the exception of one study in which GBC diagnosis was made by histological evaluation [28].…”

“…We identified two case-control studies [21,23] and seven cohort studies [27,[29][30][31][32][33][34] that presented results on diabetes and risk of biliary tract cancer. Another diabetic cohort study reported results with SMR [15].…”

Effect of liver cirrhosis on metastasis in colorectal cancer patients: a nationwide population-based cohort study

“…We first identified patients with a diagnosis of CRC (ICD-9-CM codes 153.0 to 153.9 and 154.0 to 154.2) from inpatient and outpatient claims during the study period. These CRC patients must also have been issued catastrophic illness certificates that further ensure the accuracy of cancer diagnosis (21). To ensure the inclusion of only newly diagnosed CRC between 2000 and 2010, patients who had a diagnosis of CRC between 1995 and 1999 were excluded.…”

“…False reports of diagnosis would yield a severe penalty from the BNHI (20). Therefore, information obtained from the NHIRD is considered to be complete and accurate (21). The NHIRD provided information on encrypted patient identification numbers, sex, birthday, dates of admission and discharge, medical institutions providing the services, the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes of up to five diagnoses and procedures, respectively, outcome at hospital discharge (recovered, died or transferred out), order codes and the fees charged for medical services.…”

Age- and Sex-Specific Risks of Colorectal Cancers in Diabetic Patients

“…The geographic location of each individual's NHI unit-either near the location of employment or residential area-was classified under north, central, south, or east and under either of the following urbanization statuses-urban or rural-as per the National Statistics of Regional Standard Classification (Chen et al 2010).…”