Diabetes Boosts Liver Cancer Risk in Hepatitis, Cirrhosis Cases ( HealthDay News-5/06/2008)

Diabetes doubles the risk of liver cancer in patients with chronic hepatitis C with advanced fibrosis, or cirrhosis, a Dutch study reports. Researchers at the Erasmus MC University Medical Center in Rotterdam analyzed data on 541 European and Canadian patients with chronic hepatitis C with advanced cirrhosis. Of those patients, 85 had diabetes. Patients with more severe fibrosis were more likely to have diabetes. "The prevalence of diabetes mellitus was 10.5 percent for patients with Ishak fibrosis score 4, 12.5 percent for Ishak-score 5 and 19.1 percent for Ishak-score 6," the researchers wrote. The patients were followed for a median of four years. During that time, 11 patients with diabetes and 27 patients without diabetes developed liver cancer. The five-year liver cancer occurrence rate was 11.4 percent and 5.0 percent, respectively. The study also found that being male and older were significantly associated with increased risk of liver cancer. Among patients with diabetes, there was a trend toward higher liver cancer risk as fasting glucose levels increased, which suggests that hyperinsulinemia might explain the increased liver cancer risk among diabetic patients, the study authors suggested. Whatever the mechanism, it's clear that diabetes increases the risk of liver cancer in patients with chronic hepatitis C and advanced cirrhosis, the researchers concluded.

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More liver cancer patients getting transplants  (Reuters Health-18/06/2008)

In early 2002, a new donor organ allocation system gave priority for liver transplants to people with early liver cancer. It led to a six-fold increase in the proportion of liver transplant recipients with liver cancer, research shows. The allocation system is dubbed MELD, for Model for End-Stage Liver Disease (MELD). According to data from the United Network for Organ Sharing, during the 5 years immediately before adoption of the MELD prioritizing system, 4.6 percent of liver transplant recipients had liver cancer, compared with 26 percent in the 5 years immediately after adoption of MELD. In the medical journal Gastroenterology, Dr. George N. Ioannou from the Veterans Affairs Puget Sound Health Care System, Seattle and colleagues also note that the introduction of the MELD priority system was "successful" in achieving high survival rates after transplantation for people with liver cancer.

This success is likely related to both the selection of patients with early-stage liver cancer "and the ability to promptly transplant these patients because of the arbitrarily high priority score assigned to them," the investigators say. "We hope that these results are useful in continuing to optimize the policies that guide liver transplantation for (liver cancer) in the United States," they conclude. Drs. Michael Volk and Jorge A. Marrero of the University of Michigan, Ann Arbor write in a related editorial: "The question still remains, however, if these patients receive enough benefit to justify the harm caused to other patients by the use of scarce organs."

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Mailman School of Public Health researchers report blood DNA can be early predictor of liver cancer(Yahoo News-15/04/2007)


Researchers at Columbia University’s Mailman School of Public Health have discovered a means for early detection of liver cancer. Using DNA isolated from serum samples as a baseline biomarker, the scientists examined changes in certain tumor suppressor genes that have been associated with the development of liver carcinomas. This is the first study to prospectively examine potential biomarkers for early detection of liver cancer in high-risk populations, including those with chronic hepatitis B and C virus infections. Since most hepatocellular or liver carcinomas (HCC) are diagnosed at an advanced and usually fatal stage, the development of screening methods for early detection is critical. HCC is one of the most common and rapidly fatal human malignancies. Worldwide, the almost 500,000 new cases and nearly equivalent number of fatalities illustrates the lack of effective therapeutic alternatives for this disease. 

The Mailman School researchers and colleagues studied the blood of patients enrolled in a cancer screening program in Taiwan, who provided repeated blood samples prior to diagnosis. A total of 12,000 males and over 11,900 females recruited in 1991-2 are being followed. Screenings performed by the team of Mailman School scientists found changes associated with cancer in serum DNA, presumably released from the tumor, one to nine years before actual clinical diagnosis. Certain clinical risk factors such as age and hepatitis B and C virus infections, are well documented risk factors for the development of HCC. According to the study findings, these factors coupled with smoking and alcohol status, and alterations found in this study in serum DNA, resulted in an overall predictive accuracy of 89% for detection of HCC. “These are extremely encouraging findings,” says Regina Santella, PhD, professor of Environmental Health Sciences at the Mailman School of Public Health, director of the Columbia’s NIEHS Center for Environmental Health in Northern Manhattan, and principal investigator on the research. “Having the tools to identify hepatocellular carcinoma at earlier stages, is truly a breakthrough for addressing the challenges that result from this highly lethal form of cancer.”

Dr. Santella and the team of researchers previously found that several environmental factors including aflatoxin B1, a dietary mold contaminant sometimes found in peanuts and corn; polycyclic aromatic hydrocarbons, ubiquitous environmental contaminants; and 4-aminobiphenyl, a carcinogen found in cigarette smoke, are also associated with the development of HCC. While HCC incidence is highest in East Asia and Sub-Saharan Africa, it is also increasing in the U.S primarily as a result of HCV infection. “We are not only very excited about what this means in terms of early detection for hepatocellular cancer but optimistic about how it could also be applied to other cancers,” observes Dr. Santella. The full study findings are published in the April 15, 2007 issue of Clinical Cancer Research.

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