공복 혈당과 간암 발생 위험에 관한 코호트 연구

Fasting Serum Glucose and Subsequent Liver Cancer Risk in a Korean Prospective Cohort

  • 곽진 (서울대학교 의과대학 예방의학교실) ;
  • 황승식 (국립암센터 국가암관리사업지원평가연구단) ;
  • 고광필 (서울대학교 의과대학 예방의학교실) ;
  • 전재관 (서울대학교 의과대학 예방의학교실) ;
  • 박수경 (서울대학교 의과대학 예방의학교실) ;
  • 장성훈 (건국대학교 의과대학 예방의학교실) ;
  • 신해림 (국립암센터 국가암관리사업지원평가연구단) ;
  • 유근영 (서울대학교 의과대학 예방의학교실)
  • Gwack, Jin (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Hwang, Seung-Sik (Research Institute for National Cancer Control and Evaluation, National Cancer Center) ;
  • Ko, Kwang-Pil (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Jun, Jae-Kwan (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Park, Sue-Kyung (Department of Preventive Medicine, Seoul National University College of Medicine) ;
  • Chang, Soung-Hoon (Department of Preventive Medicine, Konkuk University College of Medicine) ;
  • Shin, Hai-Rim (Research Institute for National Cancer Control and Evaluation, National Cancer Center) ;
  • Yoo, Keun-Young (Department of Preventive Medicine, Seoul National University College of Medicine)
  • 발행 : 2007.01.31

초록

Objectives : Chronic infections with hepatitis B or C and alcoholic cirrhosis are three well-known major risk factors for liver cancer. Diabetes has also been suggested as a potential risk factor. However, the findings of previous studies have been controversial in terms of the causal association. Therefore, the aim of this study was to evaluate the association between serum glucose levels and liver cancer development in a Korean cohort. Methods : Thirty-six liver cancer cases were identified in the Korean Multi-Center Cancer Cohort (KMCC). Baseline information on lifestyle characteristics was obtained via questionnaire. Serum glucose levels were measured at the study's enrollment. Relative risks (RRs) were estimated using a Cox proportional hazard regression model. The adjusting variables included age, gender, smoking history, alcohol consumption, body mass index, and hepatitis B surface antigen (HBsAg) seropositivity. Results : The RRs of serum glucose for liver caner were 1.20 (95% CI = 0.48-2.99) for the category of 100 to 125 mg/dL of serum glucose and 2.77 (95% CI = 1.24-6.18) for the >126 mg/dL serum glucose category (both compared to the <100 mg/dL category). In a subgroup analysis, the RR of serum glucose among those who were both HBsAg seronegative and non-drinkers was 4.46 (95% CI = 1.09-18.28) for those with glucose levels >100 mg/dL. Conclusions : The results of this study suggest that a high level of serum glucose can increase liver cancer risk independently of hepatitis infection and drinking history in Koreans. This study implies that glucose intolerance may be an independent risk factor for liver cancer.

키워드

참고문헌

  1. Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2002: Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase No. 5. version 2.0. Lyon: IARCPress, 2004
  2. Shin HR, Won YJ, Jung KW, Kong HJ, Yim SH, Lee JK, Noh HI, Lee JK, Pisani P, Park JG. Nationwide cancer incidence in Korea, 1999-2001; First resulting using the national cancer incidence database. Cancer Res Tr 2005; 37(6): 325-331 https://doi.org/10.4143/crt.2005.37.6.325
  3. Cheon JH, Park JW, Park KW, Kim YI, Kim SH, Lee WJ, Park HS, Park SJ, Hong EK, Kim CM. The clinical report of 1,078 cases of hepatocellular carcinomas: National Cancer Center experience. Korean J Hepatol 2004; 10(4): 288-297 (Korean)
  4. Yu MC, Yuan JM. Environmental factors and risk for hepatocellular carcinoma. Gastroentero- logy 2004; 127(5 Suppl 1): S72-78 https://doi.org/10.1016/j.gastro.2004.09.018
  5. El-Serag HB. Hepatocellular carcinoma: An epidemiologic view. J Clin Gastroenterol 2002; 35(5 Suppl 2): S72-78 https://doi.org/10.1097/00004836-200211002-00002
  6. Reid AE. Nonalcoholic steatohepatitis. Gastroenterology 2001; 121(3): 710-723 https://doi.org/10.1053/gast.2001.27126
  7. Caldwell SH, Oelsner DH, Iezzoni JC, Hespenheide EE, Battle EH, Driscoll CJ. Cryptogenic cirrhosis: Clinical characterization and risk factors for underlying disease. Hepatology 1999; 29(3): 664-669 https://doi.org/10.1002/hep.510290347
  8. Yoo KY, Shin HR, Chang SH, Lee KS, Park SK, Kang D, Lee DH. Korean multi-center cancer cohort study including a biological materials bank (KMCC-I). Asian Pac J Cancer Prev 2002; 3(1): 85-92
  9. Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, Kitzmiller J, Knowler WC, Lebovitz H, Lernmark A, Nathan D, Palmer J, Rizza R, Saudek C, Shaw J, Steffes M, Stern M, Tuomilehto J, Zimmet P. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26(11): 3160-3167 https://doi.org/10.2337/diacare.26.11.3160
  10. Jee SH, Ohrr H, Sull JW, Samet JM. Cigarette smoking, alcohol drinking, hepatitis B, and risk for hepatocellular carcinoma in Korea. J Natl Cancer Inst 2004; 96(24): 1851-1856 https://doi.org/10.1093/jnci/djh334
  11. Jee SH, Ohrr H, Sull JW, Yun JE, Ji M, Samet JM. Fasting serum glucose level and cancer risk in Korean men and women. JAMA 2005; 293(2): 194-202 https://doi.org/10.1001/jama.293.2.194
  12. Fujino Y, Mizoue T, Tokui N, Yoshimura T. Prospective study of diabetes mellitus and liver cancer in Japan. Diabetes Metab Res Rev 2001; 17(5): 374-379 https://doi.org/10.1002/dmrr.214
  13. Shibata A, Ogimoto I, Kurozawa Y, Nose T, Yoshimura T, Suzuki H, Iwai N, Sakata R, Fujita Y, Ichikawa S, Fukuda K, Tamakoshi A. Past medical history and risk of death due to hepatocellular carcinoma, univariate analysis of JACC study data. Kurume Med J 2003; 50(3- 4): 109-119 https://doi.org/10.2739/kurumemedj.50.109
  14. Davila JA, Morgan RO, Shaib Y, McGlynn KA, El-Serag HB. Diabetes increases the risk of hepatocellular carcinoma in the United States: A population based case control study. Gut 2005; 54(4): 533-539 https://doi.org/10.1136/gut.2004.052167
  15. Coughlin SS, Calle EE, Teras LR, Petrelli J, Thun MJ. Diabetes mellitus as a predictor of cancer mortality in a large cohort of US adults. Am J Epidemiol 2004; 159(12): 1160-1167 https://doi.org/10.1093/aje/kwh161
  16. Lagiou P, Kuper H, Stuver SO, Tzonou A, Trichopoulos D, Adami HO. Role of diabetes mellitus in the etiology of hepatocellular carcinoma. J Natl Cancer Inst 2000; 92(13): 1096-1099 https://doi.org/10.1093/jnci/92.13.1096
  17. Yuan JM, Govindarajan S, Arakawa K, Yu MC. Synergism of alcohol, diabetes, and viral hepatitis on the risk of hepatocellular carcinoma in blacks and whites in the U.S. Cancer 2004; 101(5): 1009-1017 https://doi.org/10.1002/cncr.20427
  18. Farrell GC, Larter CZ. Nonalcoholic fatty liver disease: From steatosis to cirrhosis. Hepatology 2006; 43(2 Suppl 1): S99-S112 https://doi.org/10.1002/hep.20973
  19. Farazi PA, DePinho RA. Hepatocellular carcinoma pathogenesis: From genes to environment. Nat Rev Cancer 2006; 6(9): 674- 687 https://doi.org/10.1038/nrc1934
  20. Kremsdorf D, Soussan P, Paterlini-Brechot P, Brechot C. Hepatitis B virus-related hepatocellular carcinoma: Paradigms for viralrelated human carcinogenesis. Oncogene 2006; 25(27): 3823-3833 https://doi.org/10.1038/sj.onc.1209559
  21. La Vecchia C, Negri E, Decarli A, Franceschi S. Diabetes mellitus and the risk of primary liver cancer. Int J Cancer 1997; 73(2): 204-207 https://doi.org/10.1002/(SICI)1097-0215(19971009)73:2<204::AID-IJC7>3.0.CO;2-#
  22. Hassan MM, Hwang LY, Hatten CJ, Swaim M, Li D, Abbruzzese JL, Beasley P, Patt YZ. Risk factors for hepatocellular carcinoma: Synergism of alcohol with viral hepatitis and diabetes mellitus. Hepatology 2002; 36(5): 1206-1213 https://doi.org/10.1053/jhep.2002.36780
  23. Bugianesi E, Leone N, Vanni E, Marchesini G, Brunello F, Carucci P, Musso A, De Paolis P, Capussotti L, Salizzoni M, Rizzetto M. Expanding the natural history of nonalcoholic steatohepatitis: From cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology 2002; 123(1): 134-140 https://doi.org/10.1053/gast.2002.34168
  24. Gupta K, Krishnaswamy G, Karnad A, Peiris AN. Insulin: A novel factor in carcinogenesis. Am J Med Sci 2002; 323(3): 140-145 https://doi.org/10.1097/00000441-200203000-00004
  25. Vara JAF, Casado E, Castro J, Cejas P, Belda- Iniesta C, Gonzalez-Baron M. PI3K/Akt signalling pathway and cancer. Cancer Treat Rev 2004; 30(2):193-204 https://doi.org/10.1016/j.ctrv.2003.07.007
  26. Hanada M, Feng J, Hemmings BA. Structure, regulation and function of PKB/AKT--a major therapeutic target. Biochim Biophys Acta 2004; 1697(1-2): 3-16 https://doi.org/10.1016/j.bbapap.2003.11.009
  27. Organization WH. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complication. Geneva: WHO, 1999
  28. Jo MW, Khang YH, Yun S, Lee JY, Lee MS, Lee SI. Proportion of death certificates issued by physicians and associated factors in Korea, 1990-2002. J Prev Med Pub Health 2004; 37(4): 345-353 (Korean)
  29. Oh KC, Park SH, Park JC, Jin do K, Park CS, Kim KO, Jang HJ, Lee JY, Park CH, Han TH, Yoo KS, Kim JH, Kim DJ, Lee MS, Park CK. Is the prevalence of cryptogenic hepatocellular carcinoma increasing in Korea? Korean J Gastroenterol 2005; 45(1): 45-51 (Korean)