Several studies demonstrated an association between type 2 diabetes (T2D) and a higher risk of hepatocellular carcinoma (HCC). Metformin is widely prescribed for T2D. Metformin has been shown to prevent various cancer developments. The association of metformin use and development of HCC among T2D with cirrhosis is investigated. This study aims to determine if metformin significantly reduces the incidence of HCC in this population. T2D with cirrhosis patients from 2006 to 2014 with age 20 to 80 years were studied as a retrospective cohort. An incidence of HCC in T2D with/without metformin exposure after cirrhosis diagnosis within 5 years was determined by Chi-square test. The exposure was defined as a drug intake at the time of cirrhosis diagnosis, continuing for at least 90 days beyond the diagnosis. The 5-year disease-free survival of HCC in each group was compared using the log-rank test and Kaplan-Meier method. The total of 1,061 T2D with cirrhosis included metformin exposure (N=719) and metformin non-exposure (N=342). The overall HCC incidence was 253 (23.85%). Among patients with metformin exposure, the HCC incidence was 125 (17.39%), compared to 128 (37.42%) in non-exposure group. The development of HCC within 5 years was significantly lower in metformin exposure than in non-exposure group (RR=0.76; 95% CI:0.69-0.83; P<0.001). The 5-year disease-free survival of HCC with metformin exposure is greater than that of non-exposure (0.80 vs. 0.57; HR=0.42; 95% CI:0.33-0.54; p<0.001). Moreover, the result shows that male gender (HR=1.64; 95% CI:1.25-2.14), HbA1C≥7.5% (HR=1.30; 95% CI:1.00-1.68), HBV cirrhosis (HR=1.80; 95% CI:1.13-2.85), HCV cirrhosis (HR=2.31; 95% CI:1.43-3.74), smoking and drinking cessation ≥5 years (HR=1.78; 95% CI:1.31-2.42 and HR=1.74; 95% CI:1.27-2.38 respectively) were linked to a rising 5-year HCC incidence in T2D.
Conclusion: The metformin treatment might reduce the incidence of HCC in T2D with cirrhosis during 5-years and benefit HCC prognosis.
T. Tangjarusritaratorn: None. T. Kunavisarut: None. W. Tangjittipokin: None.