Association of exogenous insulin or sulphonylurea treatment with an increased incidence of hepatoma in patients with hepatitis C virus infection.

BACKGROUND: Diabetes mellitus is frequently seen in hepatitis C patients and is often treated with antidiabetic agents that increase serum insulin levels. Because insulin is a growth-promoting hormone, antidiabetic agents could pose a risk for hepatocellular carcinoma (HCC). AIM: The aim of this study was to investigate an association between antidiabetic therapies and the incidence of HCC in hepatitis C patients with diabetes mellitus. METHODS: A nested case-control study was conducted. Participants were recruited from a cohort study, in which patients with hepatitis C were consecutively registered. Participants were assigned to an HCC group (n=138) or a non-HCC group (n=103). To identify independent factors, variables including use of antidiabetic agents were analysed by logistic regression analysis. RESULTS: Besides ageing, being male, cirrhosis and hypoalbuminaemia, use of exogenous insulin and a second-generation sulphonylurea were significant independent factors associated with an incidence of HCC [odds ratio (OR) 2.969, 95% confidence interval (CI) 1.293-6.819, P<0.0103 and OR 6.831, 95% CI 1.954-23.881, P<0.0026 respectively). In stratified analyses, the impact of these antidiabetic agents was more evident in patients who were non-cirrhotic than in those who were cirrhotic. CONCLUSIONS: Exogenous insulin and a second-generation sulphonylurea were independent variables associated with an incidence of HCC in hepatitis C patients with diabetes mellitus. This association was evident in patients who were non-cirrhotic. To verify a causal relationship between these antidiabetic agents and the development of HCC, a prospective cohort study is required.

A case report of primary hepatic squamous cell carcinoma that remarkably responded to low dose arterial injection of anti-cancer drugs.

Primary hepatic squamous cell carcinoma is rare. In this case, a malignant lesion was detected in bilateral hepatic lobes by ultrasound sonography and computed tomography. The maximum tumor diameter was approximately 10 cm. Tumor tissue obtained by aspiration liver biopsy was diagnosed as poorly differentiated squamous cell carcinoma. In gallium radioisotope scanning, no focus was detected in any organs other than the liver. As therapy, anti-cancer drugs were administered via hepatic arterial infusion. The patient received 10 mg of cis-diaminedichloroplatinum (CDDP) and 250 mg of 5-fluorouracil (5-FU) for 5 days every week. The therapy was continued for 3 weeks, and the same doses of CDDP and 5-FU were given to the patient once per 2 weeks in the clinic. The intrahepatic tumor lesion began to decrease from the start of treatment, and had almost disappeared 8 months after. Recurrence of the liver tumor occurred at 12 months from the start of treatment. The patient was re-admitted and treated with the same anti-cancer drugs via hepatic arterial injection. However, the drugs showed remarkable effect no longer and she died in month 23. The treatment with chemotherapy via hepatic arterial injection for a patient with squamous cell carcinoma offered a favorable therapeutic effect.