Objective: Diabetes mellitus is closely associated with chronic HCV infection, which contributes to the 25% of the global hepatocellular carcinoma (HCC) cases. The aim of this study was the assessment of diabetes impact on HCC occurrence in HCV patients treated with Direct Acting Antivirals (DAAs).
Patients and Methods: According to Italian ministerial guidelines for DAAs treatment, 208 HCV patients treated with DAAs were enrolled. Abdominal ultrasound was performed before starting antiviral therapy and, thereafter, repeated every six months. HCC and diabetes diagnosis were performed according to the international guidelines. Liver stiffness measurement and all laboratory tests were performed before the treatment.
Results: HCC was diagnosed in 31 patients with chronic HCV infection under DAAs interferon-free therapy. The prevalence of diabetes was 32.3%. At the univariate analysis, HCC development was associated with older age (p=0.0007), sex (p<0.0001), liver stiffness (median 35.8 vs. 20.6 kPa; p<0.0001), smoke (p=0.010), metabolic syndrome (p<0.0001), bright liver (p=0.007) and number of focal lesions (p<0.0001). At the multivariate analysis, age (p=0.045), liver stiffness (p=0.007), platelet (p=0.002) count and Child-Pugh B score (p=0.048) at baseline revealed as independent predictors of HCC development. The Kaplan Meier analysis showed a statistically significant difference in terms of HCC cumulative risk based on diabetes mellitus duration, stratified according to metabolic syndrome presence/absence (log-rank p=0.002).
Conclusions: Diabetes and MS are two important risk factors associated with cancer. Even in cirrhotic patients who have obtained the viral clearance, a careful ultrasound monitoring is mandatory, especially in inveterate cirrhosis.