title: Diabetes mellitus is associated with hepatocellular carcinoma: a retrospective case-control study in hepatitis endemic area.
abstract: BACKGROUND
  A number of case-control patient studies have been conducted to investigate the association between diabetes mellitus (DM) and hepatocellular carcinoma (HCC). Despite some controversial reports, it has been suggested that DM is associated with HCC. The previous studies on this subject vary in the selection of populations, sample sizes, methodology, and analysis results. Therefore, it is necessary to further delineate the involvement of DM, together with other related risk factors, in HCC with large sample size and strict analysis methodology.
  
  
  METHODS
  We conducted a hospital-based retrospective case-control study at Perking Union Medical College Hospital, China. A total of 1,568 patients with liver diseases were enrolled in the statistical study to evaluate the association of DM and other risk factors with HCC. Among these patients, 716 of them were diagnosed with benign liver diseases, and 852 patients were diagnosed as HCC. We utilized binary logistic regression and stepwise logistic regression to investigate the associations among DM, hypertension, fatty liver, cirrhosis, gallstone, HBV infection, HCV infection, and HCC.
  
  
  RESULTS
  Statistical analysis through the stepwise regression model indicated that the prevalence of DM, male gender, cirrhosis, HCV infection, or HBV infection is higher in the HCC patient group compared to the control group. However, the prevalence of gallstone is negatively associated with HCC cases. DM co-exists with HBV infection, male gender, and age in the HCC cases. Binary logistic regression analysis suggested that DM may synergize with HBV infection in HCC development.
  
  
  CONCLUSIONS
  DM is strongly associated with the increased risk of HCC regardless of the prevalence of HBV infection, HCV infection, cirrhosis, male gender, and age. However, the synergistic interaction between DM and HBV in HCC occurrence is significant. Therefore, DM patients with HBV infection represent a very high HCC risk population and should be considered for HCC close surveillance program.
authors.affiliation: Center for Molecular Medicine & Genetics, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
authors.forename: Ze
authors.initials: Z
authors.lastname: Zheng
authors.affiliation: Center for Molecular Medicine & Genetics, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
authors.forename: Chao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Yan
authors.affiliation: Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Ruan
authors.affiliation: Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Hepatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Xingting
authors.initials: X
authors.lastname: San
authors.affiliation: Department of Hepatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Yilei
authors.initials: Y
authors.lastname: Mao
authors.affiliation: Division of Cardiovascular Medicine, Davis Heart & Lung Research Institute, College of Medicine, Ohio State University, Columbus, Ohio, United States of America ; Division of Environmental Health Sciences, College of Public Health, Ohio State University, Columbus, Ohio, United States of America.
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Sun
authors.affiliation: Center for Molecular Medicine & Genetics, Wayne State University School of Medicine, Detroit, Michigan, United States of America ; Department of Immunology and Microbiology, Wayne State University School of Medicine, Detroit, Michigan, United States of America.
authors.forename: Kezhong
authors.initials: K
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Zhongjie
authors.initials: Z
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012189:Retrospective Studies; D012307:Risk Factors