Diabetes Mellitus, Obesity and Underlying Non Alcoholic Fatty Liver Disease - Independent Risk Factors for Hepatocellular Carcinoma

Abstract Background and Aims. Hepatocellular carcinoma (HCC) is one of the most common malignancies. Obesity, together with the underlying liver steatosis, has received increased attention as a risk factor for HCC. Diabetes Mellitus (DM) is also reported to be associated with HCC. We aimed to estimate the risk of HCC in obese and diabetic patients. Material and method. We prospectively analyzed 414 obese and diabetic patients, over a period of 5 years. We evaluated all patients using screening methods such as abdominal ultrasound and serum alpha-fetoprotein every 6 month, in order to detect HCC occurrence. Kaplan-Meier analysis estimated the cumulative incidence of HCC. Univariate and multivariate Cox regression analysis assessed the association between HCC and obesity. Results. Median follow-up was 4.3 years. 11 from 77 cirrhotic obese patients, and 18 from 150 non-cirrhotic obese patients developed HCC (p=ns). 7 from 51 patients with DM and cirrhosis, and 14 from 136 non-cirrhotic patients with DM developed HCC (p=ns). The cumulative incidence of HCC was 2.8%, respectively 2.6%, in cirrhotic patients with obesity or DM, compared with 2.2%, respectively 2.0%, in non-cirrhotic patients with obesity or DM (p=ns). Conclusion. Obesity and DM, along with nonalcoholic fatty liver disease (NAFLD), seems to be independent risk factors for HCC occurrence.

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