Diabetes and hepatocellular cancer risk: not only a matter of hyperglycemia.
Diabetes and hepatocellular cancer risk: not only a matter of hyperglycemia.
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DOI：
10.1002/hep.25646
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发表时间：
2012-04-01
期刊：
影响因子：
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通讯作者：
Forlani, Gabriele
中科院分区：
文献类型：
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作者：
Marchesini, Giulio;Forlani, Gabriele
糖尿病和肝细胞癌（HCC）的研究结果不一致。这项荟萃分析旨在研究糖尿病与HCC风险之间的关系。通过检索截至2011年2月的PUBMED和MEDLINE数据库确定研究。使用随机效应模型计算合并风险估计值。通过亚组分析探索异质性的潜在来源。共纳入17项病例对照研究和32项队列研究。所有研究的合并风险估计显示，糖尿病个体中HCC患病率的风险在统计学上显著增加（RR= 2.31，95%CI：1.87-2.84）。17项病例对照研究的合并风险估计值（OR= 2.40，95%CI：1.85-3.11）略高于25项队列研究的合并风险估计值（RR= 2.23，95%CI：1.68-2.96）。二甲双胍治疗具有潜在的保护作用。相反，长期糖尿病和磺脲类药物或胰岛素治疗可增加HCC风险。此外，7项队列研究的荟萃分析发现，糖尿病患者（与非糖尿病患者相比）的HCC死亡风险在统计学上显著增加（RR= 2.43，95% CI：1.66-3.55）。这项荟萃分析显示，糖尿病与HCC发病率和HCC死亡率的中度增加相关。考虑到糖尿病患病率的迅速增加，该研究强调了糖尿病患者预防癌症的必要性。肝癌的发病机制以及肝癌与糖尿病的类型、严重程度、治疗和病程之间的关系有待进一步研究。
Studies of diabetes and hepatocellular carcinoma (HCC) yielded inconsistent findings. This meta-analysis was conducted to examine the association between diabetes and risk of HCC. Studies were identified by searching PUBMED and MEDLINE database up to February 2011. Pooled risk estimates were calculated using the random-effects model. Potential sources of heterogeneity were explored by subgroup analyses. A total of 17 case-control studies and 32 cohort studies were included in the meta-analysis. The combined risk estimate of all studies showed a statistically significant increased risk of HCC prevalence among diabetic individuals (RR= 2.31, 95% CI: 1.87–2.84). The pooled risk estimate of 17 case-control studies (OR= 2.40, 95% CI: 1.85–3.11) was slightly higher than that from 25 cohort studies (RR= 2.23, 95% CI: 1.68–2.96). Metformin treatment was potentially protective. On the contrary, long duration of diabetes and sulfonylureas or insulin treatment could increase HCC risk. Also meta-analysis of 7 cohort studies found a statistically significant increased risk of HCC mortality (RR= 2.43, 95% CI: 1.66–3.55) for individuals with (versus without) diabetes. This meta-analysis shows that diabetes is associated with moderately increased risk of HCC incidence, as well as HCC mortality. Considering the rapidly increasing prevalence of diabetes mellitus, the study underlines the need for cancer prevention in diabetic individuals. Further investigation is needed to focus on the potential mechanism for the pathogenesis of HCC and the link between HCC and different types, severity, treatment and duration of diabetes.