SNFGE SNFGE
 
Thématique :
- Carcinome hépatocellulaire (CHC)
- Foie (hors cancers)
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2017/11  
 
  2017 Nov .  
  doi: 10.1002/hep.29660.  
 
  Diabetes, Metabolic Comorbidities and Risk of Hepatocellular Carcinoma: Results from Two Prospective Cohort Studies.  
 
  Simon TG, King LY, Chong DQ, Nguyen L, Ma Y, VoPham T, Giovannucci EL, Fuchs CS, Meyerhardt JA, Corey KE, Khalili H, Chung RT, Zhang X, Chan AT  
  https://www.ncbi.nlm.nih.gov/pubmed/29152763  
 
 

Abstract

BACKGROUND:

Type 2 diabetes (T2D) is a risk factor for hepatocellular carcinoma (HCC). However, it is unknown whether T2D duration or additional metabolic comorbidities further contribute to HCC risk.

METHODS:

From the Nurses' Health Study (NHS), 120,826 women were enrolled in 1980, and from the Health Professionals Follow-up Study (HPFS), 50,284 men were enrolled in 1986, and followed through 2012. Physician-diagnosed T2D was ascertained at baseline and updated biennially. Cox proportional hazards regression models were used to calculate age- and multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for incident HCC.

RESULTS:

Over 32 years of follow-up (4,488,410 person-years), we documented 112 cases of HCC (69 women, 43 men). T2D was associated with an increased HCC risk (multivariable HR 4.59, 95% CI 2.98-7.07), as was an increasing T2D duration (Ptrend <0.001). Compared to non-diabetics, the multivariable HRs for HCC were 2.96 (95% CI 1.57-5.60) for 0 to <2 years; 6.08 (95% CI 2.96-12.50) for 2 to <10 years; and 7.52 (95% CI 3.88-14.58) for ≥10 years. Increasing number of metabolic comorbidities (T2D, obesity, hypertension, dyslipidemia) was associated with increased HCC risk (Ptrend <0.001); compared to individuals without metabolic comorbidity, those with four metabolic comorbidities had an 8.1-fold increased HCC risk (95% CI 2.48-26.7). In T2D, neither insulin use nor oral hypoglycemic use was significantly associated with HCC risk (HR 2.04 [95% CI 0.69-6.09], and HR 1.45 [95% CI 0.69-3.07] respectively).

CONCLUSIONS:

T2D is independently associated with increased risk for HCC, in two prospective cohorts of U.S. men and women. This risk is enhanced with prolonged diabetes duration and with comorbid metabolic conditions, suggesting the importance of insulin resistance in the pathogenesis of HCC. This article is protected by copyright. All rights reserved.

 

 
Question posée
 
Le diabète de type 2 étant un facteur de risqué de carcinome hépatocellulaire, est-ce que sa durée et des co-morbidités associées aggrave ce risque de carcinome hépatocellulaire?
 
Question posée
 
Dans les 2 cohortes américaines suivies pendant une trentaine d’années, le diabète et sa durée augmentent significativement le risque de carcinome hépatocellulaire d’un facteur 3 dans les 2 ans et d’un facteur 6 après. Les co-morbidités augmentant le plus le risque sont l’obésité, l’hypertension et la dyslipidémie qui ajoutées ensemble au diabète multiplient par 8 le risque d carcinome hépatocellulaire.
 
Commentaires

Cette étude souligne l’importance de l’insulino-résistance dans la genèse du CHC mais surtout de trouver rapidement des outils pour cibler la recherche et surtout la prévention du carcinome hépatocellulaire : fibrose ? Autres ?

 
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