Setiawan Veronica Wendy, Hernandez Brenda Y, Lu Shelly C, Stram Daniel O, Wilkens Lynne R, Le Marchand Loic, Henderson Brian E
Department of Preventive Medicine, Keck School of Medicine, and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (VWS, DOS, BEH); University of Hawaii Cancer Center, Honolulu, HI (BYH, LRK, LLM); USC Research Center for Liver Diseases, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA (SCL).
J Natl Cancer Inst. 2014 Oct 18;106(12). doi: 10.1093/jnci/dju326. Print 2014 Dec.
Diabetes is an emerging risk factor for hepatocellular carcinoma (HCC), but prospective data from different ethnic populations are scarce. We examined the association between diabetes and HCC in 168679 African Americans, Native Hawaiians, Japanese Americans, Latinos and whites in the Multiethnic Cohort.
During a 15.7-year follow up period, 470 incident HCC cases were identified. Risk factor data were obtained from the baseline questionnaire. Cox regressions were used to calculate hazard rate ratios (RRs) and 95% confidence intervals (CIs) for HCC associated with self-reported diabetes. The population attributable risk percent associated with diabetes was also calculated. All statistical tests were two-sided.
The RRs for developing HCC (vs whites) were 2.73 (95% CI = 2.00 to 3.72) for Latinos, 2.48 (95% CI = 1.59 to 3.87) for Hawaiians, 2.16 (95% CI = 1.52 to 3.07) for African Americans, and 2.05 (95% CI = 1.50 to 2.81) for Japanese. Diabetes was associated with HCC across ethnic groups (RRLatinos = 3.36 [95% CI = 2.41 to 4.70], RRHawaiians = 2.50 [95% CI = 1.11 to 5.64], RRJapanese = 2.34 [95% CI = 1.60 to 3.41], RRwhites = 2.15 [95% CI = 0.95 to 4.90], and RRAfrican Americans = 2.02 [95% CI = 1.17 to 3.48]). We estimated that 27% of HCC cases in Latinos, 18% in Hawaiians, 13% in African Americans, 12% in Japanese, and 6% in whites were attributed to diabetes.
Latinos were at the highest risk of developing HCC, followed by Native Hawaiians, African Americans, Japanese and whites. Diabetes is a risk factor for HCC in all ethnic groups, and eliminating diabetes could potentially reduce HCC incidence in all ethnic groups, with the largest potential for reduction in Latinos.
糖尿病是肝细胞癌（HCC）新出现的一个风险因素，但来自不同种族人群的前瞻性数据很少。我们在多民族队列研究中，对168679名非裔美国人、夏威夷原住民、日裔美国人、拉丁裔和白人中糖尿病与肝细胞癌的关联进行了研究。
在15.7年的随访期内，共确定了470例肝细胞癌新发病例。风险因素数据来自基线调查问卷。采用Cox回归分析计算自我报告的糖尿病与肝细胞癌相关的风险率比值（RRs）和95%置信区间（CIs）。还计算了与糖尿病相关的人群归因风险百分比。所有统计检验均为双侧检验。
拉丁裔患肝细胞癌（与白人相比）的RRs为2.73（95%CI = 2.00至3.72），夏威夷人为2.48（95%CI = 1.59至3.87），非裔美国人为2.16（95%CI = 1.52至3.07），日裔为2.05（95%CI = 1.50至2.81）。糖尿病在所有种族群体中均与肝细胞癌相关（拉丁裔RR = 3.36 [95%CI = 2.41至4.70]，夏威夷人RR = 2.50 [95%CI = 1.11至5.64]，日裔RR = 2.34 [95%CI = 1.60至3.41]，白人RR = 2.15 [95%CI = 0.95至4.90]，非裔美国人RR = 2.02 [95%CI = 1.17至3.48]）。我们估计，拉丁裔中27%的肝细胞癌病例、夏威夷人中18%、非裔美国人中13%、日裔中12%以及白人中6%可归因于糖尿病。
拉丁裔患肝细胞癌的风险最高，其次是夏威夷原住民、非裔美国人、日裔和白人。糖尿病是所有种族群体患肝细胞癌的一个风险因素，消除糖尿病可能会降低所有种族群体的肝细胞癌发病率，其中拉丁裔降低的潜力最大。
