Original articleThe Association Between Diabetes and Hepatocellular Carcinoma: A Systematic Review of Epidemiologic Evidence
Section snippets
Literature Search
We searched MEDLINE for studies published in English from January 1966 through February 2005. The search strategy included “diabetes AND (hepatocellular carcinoma OR HCC OR liver cancer) AND (risk OR odds OR incidence).” A hand search of cited bibliographies also was performed. Only fully published articles were considered.
Study Selection Criteria
We searched for analytic epidemiologic studies (cross-sectional, case-control, or cohort study design) that examined the association between diabetes and HCC. We excluded
Case-Control Studies
Thirteen case-control studies met the inclusion and exclusion criteria of the review.13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 The characteristics of these studies are shown in Table 1. Five studies were from the United States, 2 from Greece, 2 from Italy, 1 from the United Kingdom, and 3 studies were from the same single-district hospital in Japan. Diabetes was defined based on in-person or mailed questionnaires in 10 studies and based on chart review or diagnostic codes in 3 studies.
Discussion
This systematic review of published epidemiologic studies indicates that type 2 diabetes is associated with an approximately 2.5-fold increase in the risk for HCC. The risk estimate from 13 case-control studies indicates a statistically significant 2.5-fold increased odds of diabetes among patients with HCC compared with controls without diabetes. Similarly, the pooled estimates from 13 cohort studies indicate a statistically significant 2.5-fold increase in HCC incidence among patients with
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