In some studies, insulin use in diabetes

was also reported to be associated with hepatocellular carcinoma4 and in turn increased cancer-related mortality.34 Compared with control subjects without clinical risk factors, diabetic patients with hepatitis B and C in our study had significantly increased risk of malignant neoplasm of the liver by magnitudes comparable with those of previous studies.11, 14 The HR BYL719 cost of diabetic patients with cirrhosis in our findings was also higher than those with alcoholic liver disease including cirrhosis, which was similar to the findings from a population-based United States study.14 Screening of every diabetic patient for hepatic neoplasm might not be cost-effective, because these outcomes are rare even among diabetic patients. However, the HRs of diabetic patients with hepatitis B, hepatitis C, and cirrhosis were significantly increased enough that diabetologists should educate patients with Everolimus concentration those clinical risk factors for strict adherence to the present liver cancer screening program. Although some other potential confounding

factor such as obesity35 might be responsible for the increased risk of liver cancer rather than diabetes itself, one previous study7 that adjusted for body mass index (BMI) in a multivariate analysis found that BMI had no effect on the significant association of diabetes and hepatocellular carcinoma. Stattin et al.21 also reported that adjustment for BMI had no material effect on risk estimates of hyperglycemia and cancer risk. A recent Taiwanese study36 prospectively Chorioepithelioma followed 2,903 male hepatitis B virus surface antigen-positive government employees for a mean of 14.7 years, and reported a significant increase in the risk of hepatocellular carcinoma (HR 1.48, 95% CI 1.04-2.12) in overweight men (BMI between 25.0 and 29.9 kg/m2). The HR increased to 1.96

(95% CI 0.72-5.38) in obese men (BMI ≥30.0 kg/m2). This study thus concluded that excess body weight is involved in the transition from healthy hepatitis B carrier state to hepatocellular carcinoma among men. Nonetheless, our study demonstrated that, even in the absence of hepatitis B, diabetic patients were still at a significantly greater risk of liver cancer. Because no anthropometric data are available from the NHI data, we were unable to empirically assess the extent to which obesity would confound the relationship between diabetes and liver cancer observed in our study. The incidence of biliary tract cancers of diabetic patients was scarcely investigated in the literature. Irrespective of diabetic status, the incidence of biliary tract neoplasm increased with age, and they were higher in men than in women except in those diabetic patients >64 years.