SNFGE SNFGE
 
Thématique :
- Foie
- Carcinome hépatocellulaire (CHC)
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/05  
 
  2018 May;67(5):1797-1806.  
  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 LH, 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

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. 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 (CIs) for incident HCC. 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 nondiabetics, the multivariable HRs for HCC were 2.96 (95% CI, 1.57-5.60) for 0-<2 years; 6.08 (95% CI, 2.96-12.50) for 2-<10 years; and 7.52 (95% CI, 3.88-14.58) for ≥10 years. Increasing number of metabolic comorbidities (T2D, obesity, hypertension, and 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).

CONCLUSION:

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. (Hepatology 2018;67:1797-1806).

 

 
Question posée
 
Est-ce que le risque de carcinome hépatocellulaire (CHC) est associé au diabète de type 2 (T2D) et à sa durée ainsi qu’à d’autres co-morbidités métaboliques à partir du suivi de 2 cohortes de femmes et d’hommes sur un suivi de plus de 30 ans ?
 
Question posée
 
Il existe bien un sur-risque de CHC lié au T2D ainsi qu’à sa durée avec un risque multiplié par 3 par rapport aux sujets non diabétiques pour une durée du T2D de 2 à 10 ans et par 7,5 pour une durée de plus de 10 ans et par 8 avec 4 co-morbidités métaboliques (T2D, obésité, HTA, dyslipidémie).
 
Commentaires

Cette étude confirme bien le rôle important de l’insulino-résistance dans la survenue du CHC sans cirrhose mais ne dit pas comment en faire le diagnostic précoce…

 
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