title: Predictors of Increased Risk of Hepatocellular Carcinoma in Patients with Type 2 Diabetes.
abstract: Epidemiological data indicate that type 2 diabetes is associated with increased risk of hepatocellular carcinoma (HCC). However, risk stratification for HCC has not been fully elucidated in diabetic population. The aim of this study was to identify potential predictors of HCC in diabetic patients without chronic viral hepatitis. A cohort of 3,544 diabetic patients without chronic viral hepatitis or alcoholic cirrhosis was established and subjects were randomly allocated into a derivation and a validation set. A scoring system was developed by using potential predictors of increased risk of HCC from the Cox proportional hazards model. The performance of the scoring system was tested for validation by using receiver operating characteristics analysis. During median follow-up of 55 months, 36 cases of HCC developed (190 per 100,000 person-years). The 5- and 10-year cumulative incidences of HCC were 1.0%, and 2.2%, respectively. Multivariate Cox regression analysis showed that age > 65 years, low triglyceride levels and high gamma-glutamyl transferase levels were independently associated with an increased risk of HCC. DM-HCC risk score, a weighted sum of scores from these 3 parameters, predicted 10-year development of HCC with area under the receiver operating characteristics curve of 0.86, and discriminated different risk categories for HCC in the derivation and validation cohort. In conclusion, old age, low triglyceride level and high gamma-glutamyl transferase level may help to identify individuals at high risk of developing HCC in diabetic patients without chronic viral hepatitis or alcoholic cirrhosis.
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Won Keun
authors.initials: WK
authors.lastname: Si
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Jung Wha
authors.initials: JW
authors.lastname: Chung
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Junhyeon
authors.initials: J
authors.lastname: Cho
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Joo Yeong
authors.initials: JY
authors.lastname: Baeg
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Jang
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Hyuk
authors.initials: H
authors.lastname: Yoon
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jaihwan
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Cheol Min
authors.initials: CM
authors.lastname: Shin
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Park
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jin-Hyeok
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Sook-Hyang
authors.initials: SH
authors.lastname: Jeong
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Dong Ho
authors.initials: DH
authors.lastname: Lee
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Soo
authors.initials: S
authors.lastname: Lim
authors.affiliation: Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.|Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jin-Wook
authors.identifier: http://orcid.org/0000-0003-0934-3344
authors.initials: JW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000378:metabolism*; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000378:metabolism*
chemical_list: D014280:Triglycerides; D005723:gamma-Glutamyltransferase