TANIAI Makiko    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Associate Professor
Article types	Original article
Language	English
Peer review	Non peer reviewed
Title	Hepatocellular carcinoma development in diabetic patients: a nationwide survey in Japan.
Journal	Formal name：Journal of gastroenterology Abbreviation：J Gastroenterol ISSN code：14355922/09441174
Domestic / Foregin	Foregin
Volume, Issue, Page	56(3),pp.261-273
Author and coauthor	Tateishi Ryosuke, Matsumura Takeshi, Okanoue Takeshi, Shima Toshihide, Uchino Koji, Fujiwara Naoto, Senokuchi Takafumi, Kon Kazuyoshi, Sasako Takayoshi, Taniai Makiko, Kawaguchi Takumi, Inoue Hiroshi, Watada Hirotaka, Kubota Naoto, Shimano Hitoshi, Kaneko Shuichi, Hashimoto Etsuko, Watanabe Sumio, Shiota Goshi, Ueki Kohjiro, Kashiwabara Kosuke, Matsuyama Yutaka, Tanaka Hideo, Kasuga Masato, Araki Eiichi, Koike Kazuhiko,
Publication date	2021/03
Summary	BACKGROUND:Although type 2 diabetes mellitus (T2DM) is a known risk factor for hepatocellular carcinoma (HCC) development, the annual incidence in diabetes patients is far below the threshold of efficient surveillance. This study aimed to elucidate the risk factors for HCC in diabetic patients and to determine the best criteria to identify surveillance candidates.METHODS:The study included 239 patients with T2DM who were diagnosed with non-viral HCC between 2010 and 2015, with ≥ 5 years of follow-up at diabetes clinics of 81 teaching hospitals in Japan before HCC diagnosis, and 3277 non-HCC T2DM patients from a prospective cohort study, as controls. Clinical data at the time of and 5 years before HCC diagnosis were collected.RESULTS:The mean patient age at HCC diagnosis was approximately 73 years, and 80% of the patients were male. The proportion of patients with insulin use increased, whereas the body mass index (BMI), proportion of patients with fatty liver, fasting glucose levels, and hemoglobin A1c (HbA1c) levels decreased significantly in 5 years. In the cohort study, 18 patients developed HCC during the mean follow-up period of 4.7 years with an annual incidence of 0.11%. Multivariate logistic regression analyses showed that the FIB-4 index was an outstanding predictor of HCC development along with male sex, presence of hypertension, lower HbA1c and albumin levels, and higher BMI and gamma-glutamyl transpeptidase levels. Receiver-operating characteristic analyses showed that a FIB-4 cut-off value of 3.61 could help identify high-risk patients, with a corresponding annual HCC incidence rate of 1.1%.CONCLUSION:A simple calculation of the FIB-4 index in diabetes clinics can be the first step toward surveillance of HCC with a non-viral etiology.
DOI	10.1007/s00535-020-01754-z
PMID	33427937