Ultrasonography screening for hepatocellular carcinoma in Japanese patients with diabetes mellitus.
BACKGROUND
Effective surveillance for hepatocellular carcinoma (HCC) in diabetes mellitus (DM) has not been established. We elucidated the risk factors for HCC in DM patients.


METHODS
From 2000 to 2014, 80 patients diagnosed with HCC for the first time who had concomittant DM but no other etiology of liver disease were enrolled as the DM-HCC group. From 2005 October to 2014, after introduction of the abdominal ultrasonography (US) report database, 2083 DM patients with no viral hepatitis, no known autoimmune hepatic diseases, and/or no evidence of alcohol abuse (>60 g/day) were enrolled as the DM-US group. Findings from the first US screening were evaluated. "Elderly" patients were defined as those aged >65 years. Clinical features of DM-HCC patients were evaluated and compared with those of DM-US patients.


RESULTS
In the DM-HCC group (54 men, 26 women), the mean (± SD age was 74.1 ± 8.5 years, and mean HbA1c and fibrosis-4 (FIB-4) index were 7.3 ± 1.3% and 4.50 ± 3.42, respectively. Mean tumor diameter was 5.7 ± 3.5 cm, there were 63/13/2/2 patients classified as Child-Pugh A/B/C/unknown, and 56/24 were single/multiple lesions. In the DM-US group, HCC was detected in three patients (0.14%; 0.3% of those classified as elderly). The mean age and FIB-4 index of these three patients (one man, two women) were 75.6 years (range 67-92 years) and 4.84 (range 2.87-6.98), respectively. Mean tumor diamter was 7.6 cm and there were one and two single and multiple lesions, respectively. In elderly DM-US patients with a high FIB-4 index (≥4), the rate of HCC detection was 5.0%.


CONCLUSIONS
Being elderly and having a high FIB-4 index are characteristic features of DM-HCC. Similar characteristics were noted for patients with HCC in the DM-US group. HCC surveillance with US is recommended for DM patients, especially those who are elderly (≥65 years) and have a high FIB-4 index.
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Atsushi
A
Hiraoka
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Marie
M
Ochi
Department of Laboratory, Ehime Prefectural Central Hospital, Ehime, Japan.
Rie
R
Matsuda
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Toshihiko
T
Aibiki
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Tomonari
T
Okudaira
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Tomoe
T
Kawamura
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Hiroka
H
Yamago
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Hiromasa
H
Nakahara
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Yoshifumi
Y
Suga
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Nobuaki
N
Azemoto
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Hideki
H
Miyata
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Yasunao
Y
Miyamoto
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Tomoyuki
T
Ninomiya
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.
Masashi
M
Hirooka
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.
Masanori
M
Abe
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.
Bunzo
B
Matsuura
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.
Yoichi
Y
Hiasa
Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
Kojiro
K
Michitaka
D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000208:ethnology; D048909:Diabetes Complications / Q000000981:diagnostic imaging* / Q000208:ethnology; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000208:ethnology; D008297:Male; D009367:Neoplasm Staging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
diabetes mellitus; fatty liver; hepatocellular carcinoma; survey; 糖尿病; 肝细胞癌; 脂肪肝; 调查。