Insulin resistance is associated with hepatocellular carcinoma in chronic hepatitis C infection

To elucidate the role of insulin resistance (IR) and serum adiponectin level in hepatocellular carcinoma (HCC) associated with chronic hepatitis C.

Clinical and biochemical characteristics were collected from 165 consecutive patients with newly diagnosed HCC. Homeostasis model assessment of IR (HOMA-IR) and serum adiponectin level were investigated in 188 patients with different stages of hepatitis C virus (HCV) infection.

Among HCC patients, type 2 diabetics (DM) was more prevalent in HCV subjects (35.6%, n = 59) compared to hepatitis B virus (HBV; 12.7%, n = 63) or non-HBV, non-HCV cases (7.1%, n = 28). In patients with chronic hepatitis C, HCC subjects had higher blood sugar (P < 0.001), insulin level (P = 0.003) and HOMA-IR (P = 0.018) than those with chronic hepatitis and advanced fibrosis. Age, male sex and body mass index were significantly associated with serum adiponectin level, whereas HOMA-IR was not. Based on stepwise logistic regression analysis, age (OR: 1.124, P < 0.001), serum insulin level (OR: 1.585, P < 0.001), HOMA-IR (OR: 0.495, P = 0.001), DM (OR: 11.601, P = 0.002) and male sex (OR: 3.877, P = 0.016) were independently associated with HCC. This result was similar even if the diabetic subjects were excluded for analysis.

Insulin resistance measured by HOMA-IR, regardless of the presence of diabetes, is significantly associated with HCC development in patients with chronic HCV infection.