Ultrasonography screening for hepatocellular carcinoma in Japanese patients with diabetes mellitus

Atsushi Hiraoka; Marie Ochi; Rie Matsuda; Toshihiko Aibiki; Tomonari Okudaira; Tomoe Kawamura; Hiroka Yamago; Hiromasa Nakahara; Yoshifumi Suga; Nobuaki Azemoto; Hideki Miyata; Yasunao Miyamoto; Tomoyuki Ninomiya; Masashi Hirooka; Masanori Abe; Bunzo Matsuura; Yoichi Hiasa; Kojiro Michitaka

doi:10.1111/1753-0407.12340

Ultrasonography screening for hepatocellular carcinoma in Japanese patients with diabetes mellitus

J Diabetes. 2016 Sep;8(5):640-6. doi: 10.1111/1753-0407.12340. Epub 2015 Nov 4.

Authors

Atsushi Hiraoka¹, Marie Ochi¹, Rie Matsuda², Toshihiko Aibiki¹, Tomonari Okudaira¹, Tomoe Kawamura¹, Hiroka Yamago¹, Hiromasa Nakahara¹, Yoshifumi Suga¹, Nobuaki Azemoto¹, Hideki Miyata¹, Yasunao Miyamoto¹, Tomoyuki Ninomiya¹, Masashi Hirooka³, Masanori Abe³, Bunzo Matsuura³, Yoichi Hiasa³, Kojiro Michitaka¹

Affiliations

¹ Gastroenterology Center, Ehime Prefectural Central Hospital, Ehime, Japan.
² Department of Laboratory, Ehime Prefectural Central Hospital, Ehime, Japan.
³ Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Ehime, Japan.

PMID: 26347476
DOI: 10.1111/1753-0407.12340

Abstract

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.

Keywords: diabetes mellitus; fatty liver; hepatocellular carcinoma; survey; 糖尿病; 肝细胞癌; 脂肪肝; 调查。.

MeSH terms

Aged
Aged, 80 and over
Asian People
Carcinoma, Hepatocellular / diagnostic imaging*
Carcinoma, Hepatocellular / ethnology
Diabetes Complications / diagnostic imaging*
Diabetes Complications / ethnology
Early Detection of Cancer / methods*
Female
Humans
Japan
Liver Neoplasms / diagnostic imaging*
Liver Neoplasms / ethnology
Male
Neoplasm Staging
Reproducibility of Results
Sensitivity and Specificity
Ultrasonography / methods*