Metformin modifies disparity in hepatocellular carcinoma incidence in men with type 2 diabetes but without chronic liver diseases.

Authors:
Chen-Pin Wang
Chen-Pin Wang
University of Texas Health Science Center San Antonio
United States
John Kuhn
John Kuhn
University of California
United States
Dimpy P Shah
Dimpy P Shah
The University of Texas MD Anderson Cancer Center
United States
Susanne Schmidt
Susanne Schmidt
The University of Queensland
Australia
Amelie G Ramirez
Amelie G Ramirez
Baylor College of Medicine
United States

Cancer Med 2019 Apr 16. Epub 2019 Apr 16.

Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio (UTHSCSA), San Antonio, Texas.

Background: We assessed racial/ethnic disparity in hepatocellular carcinoma (HCC) incidence among men with type 2 diabetes (T2D) but without chronic liver diseases (CLD), and whether metformin use modified the disparity.

Methods: Study cohort: the nationwide Veterans Administration Health Care System electronic medical records among 40-89 years old men with T2D; without CLD, cancer, cardiovascular or renal diseases previously; insulin and thiazolidinedione naive. Logistic regression analyses compared HCC incidence between race/ethnicity groups under no metformin use adjusted for covariates and inverse propensity score weights (IPSW) for race/ethnicity. The generalizability technique integrated with IPSW was incorporated to compare covariates adjusted odds ratios (aOR) of HCC associated with metformin use among race/ethnicity groups.

Results: Study cohort: N = 84 433; 79.47% non-Hispanic white (NHW), 15.5% non-Hispanic African American (NHAA), 5.03% Hispanics; 36.76% metformin users; follow-up 6.10 ± 2.87 years; age 67.8 ± 9.8 years, HbA1c 6.57 ± 0.98%; 0.14% HCC cases. Under no metformin use, HCC incidence was lower for NHAA vs NHW (aOR = 0.60 [0.40-0.92]), similar between NHW and Hispanics. Metformin was associated with reduced HCC risk: aOR = 0.57 (0.40-0.81) for NHW; aOR = 0.35 (0.25-0.47) for NHAA; aOR = 0.31 (0.22-0.43) for Hispanics. Metformin dose >1000 mg/d was neutral for NHW; less effective for NHAA (P = 0.02); more effective for Hispanics (P = 0.002).

Conclusions: In men with T2D but without CLD nor metformin use, HCC incidence was lower for NHAA compared to NHW or Hispanics; similar between NHW and Hispanics. Metformin use reduced HCC risk and modified the race/ethnicity disparity.

Impact: Metformin's heterogeneous HCC prevention effect elucidates potential interventions to modify HCC disparity in patients with T2D.

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Source
https://onlinelibrary.wiley.com/doi/abs/10.1002/cam4.2142
Publisher Site
http://dx.doi.org/10.1002/cam4.2142DOI Listing
April 2019
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References

(Supplied by CrossRef)
Racial disparity in gastrointestinal cancer risk
Ashktorab H et al.
Gastroenterology 2017

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