Higher HCC risk with increased insulin resistance

[nygirl7]

Just FYI - if you have IR you might want to also keep on top of this one too.

Better safe than sorry....I don't want to be the harbinger of doom but I know IR is a problem for some folks around here. I hate HCC if you can't tell.....no more of my friends should die of this.

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Higher HCC risk with increased insulin resistance in hepatitis C patients
May 12, 2010

Recent studies have demonstrated that type 2 diabetes mellitus (DM) is associated with high risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis C. Insulin resistance (IR), which correlates inversely with circulating adiponectin concentration, is a consistent finding in patients with type 2 DM. Chronic hepatitis C virus (HCV) infection has been reported to be associated with increased IR. Recent studies suggest that IR plays a crucial role in fibrosis progression, and has been demonstrated to have a negative impact on treatment responses to antiviral therapy in patients with chronic hepatitis C.


A research article to be published on May 14, 2010 in the World Journal of Gastroenterology addresses this question. The research team led by Dr. Hung from Kaohsiung Chang Gung Memorial Hospital prospectively investigated the IR assessed by the homeostasis model (HOMA-IR) and serum adiponectin level in two independent cohorts of consecutive newly diagnosed HCC patients and those with different clinical stages of chronic HCV infection.

Among 165 HCC patients, type 2 DM was more prevalent in HCV subjects compared to hepatitis B virus (HBV) or non-HBV, non-HCV cases. HOMA-IR was higher in HCC patients with HCV than in those with HBV infection. In 188 patients with chronic hepatitis C, HCC subjects had higher blood sugar, insulin level and HOMA-IR than those with chronic hepatitis and advanced fibrosis.

Based on stepwise logistic regression analysis, HOMA-IR was one of the independent factors associated with HCC development. This result was similar even if the diabetic subjects were excluded for analysis. The research team concluded that increased IR, regardless of the presence of diabetes, is significantly associated with HCC development in patients with chronic HCV infection.

These findings may have important prognostic and therapeutic implications in the management of chronic HCV-infected patients. Since IR is a potentially modifiable factor, therapeutic intervention aimed at decreasing IR may be warranted in these patients.

More information: Hung CH, Wang JH, Hu TH, Chen CH, Chang KC, Yen YH, Kuo YH, Tsai MC, Lu SN, Lee CM. Insulin resistance is associated with hepatocellular carcinoma in chronic hepatitis C infection. World J Gastroenterol 2010; 16(18): 2265-2271 http://www.wjgnet.com/1007-9327/full/v16/i18/2265.htm

Provided by World Journal of Gastroenterology (news : web)

http://www.physorg.com/news192880615.html

[CoWriter]

"My A1C's for the past year have ALWAYS been normal."
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From "Abnormalities of Glucose Metabolism, Including Insulin Resistance" by  
Michael Dube, MD, University of Indiana and ACTG researcher


"Importance of insulin resistance: Insulin resistance is the term used when the body needs more insulin than normal to control the blood sugar. Only when the pancreas can no longer produce sufficient insulin to overcome the resistance does diabetes occur, so TESTING THE BLOOD SUGAR ALONE WILL NOT BE ENOUGH TO ESTIMATE INSULIN RESISTANCE."

"it is clear that INSULIN RESISTANCE IS UNDESIRABLE EVEN IF THE BLOOD SUGAR REMAINS RELATIVELY NORMAL (i.e. in the non-diabetic range). It causes an increase in cardiovascular disease risk and abnormalities in blood vessel function and lipid levels. Interventions that address insulin resistance all tend to improve cardiovascular risk factors.

(editorial comment: you can perform an insulin resistance test to evaluate whether or not you are developing insulin resistance, which can preceed seeing sugar elevations in the blood and diabetes. Performing the insulin resistance test is a way to perhaps identify a potential problem BEFORE sugar in your blood is elevated)."

Co
P.S.  Insulin resistance is associated with having a high viral load, lower SVR, faster fibrosis progression....and no benefit.

[mikesimon]

Diffuse Cirrhosis-like Hepatocellular Carcinoma: A Clinically and Radiographically Undetected Variant Mimicking Cirrhosis.

Jakate S, Yabes A, Giusto D, Naini B, Lassman C, Yeh MM, Ferrell LD.

*Department of Pathology, Rush University Medical Center, Chicago, IL daggerDepartment of Pathology, University of California San Francisco Medical Center, San Francisco section signDepartment of Pathology, University of California Los Angeles Medical Center, Los Angeles, CA double daggerDepartment of Pathology, University of Pittsburgh, Pittsburgh, PA parallelDepartment of Pathology, University of Washington, Seattle, WA.
Abstract

A rare variant of hepatocellular carcinoma (HCC) is encountered that produces small cirrhosis-like nodules diffusely throughout the liver (CL-HCC), instead of a larger evident mass. This pattern remains undetected as carcinoma clinically and radiographically and is unexpectedly discovered after liver transplantation in the explanted native liver. We studied 10 such cases (9 males and 1 female, age 35 to 80 y) from 4 medical centers. The pretransplant clinical, laboratory, and radiographical studies were reviewed to determine the cause and stage of liver disease, alpha-fetoprotein (AFP) levels, and detectability of a mass on imaging. All 10 cases had underlying cirrhosis of varying etiology [3 hepatitis C virus (HCV), 3 alcoholic hepatitis, 1 hepatitis B virus, 1 autoimmune, and 2 mixed HCV/alcoholic hepatitis and hemochromatosis/HCV] and underwent orthotopic liver transplantation with no preoperative clinical suspicion of HCC. Ultrasound and/or dynamic imaging showed cirrhosis and no definite HCC. AFP levels were only mildly elevated in only 3 of 10 cases (144, 150, and 252 ng/mL). Grossly, there were innumerable (from about 20 to >1000) small CL-HCC nodules (0.2 to 0.6 cm) scattered among cirrhotic nodules. Histologically, these were well or moderately differentiated HCC, often with pseudoglandular pattern, perinodular sclerotic rims, cholestasis, frequent Mallory bodies, and small vessel invasion. In addition to the usual HCC immunophenotype, CL-HCC showed frequent ubiquitin and cytoplasmic and membranous CD10 positivity, relatively low Ki-67 proliferative index and absence of AFP immunohistochemically. CL-HCC warrants recognition as a unique HCC variant that evades pretransplant detection despite massive tumor burden, mimics cirrhotic nodules, and shows some uncommon pathologic and immunophenotypical characteristics.

http://www.ncbi.nlm.nih.gov/pubmed/20463569

[susan400]

Thanks for the info, but I'm going to just stick with what my doctor's are telling me.  I've been having to go to the doctor's too much already with upteen tests and procedures and quite frankly, I'm just sick and tired of being in the doctor's office and being stuck and scanned and poked and prodded!  Recently, I went through this whole thing with the rheumatologist running all these blood tests, having me get an MRI of my knee which has swelling and after all that expense and testing and procedures, nothing was ever able to be diagnosed in a definitive fashion.  Every 3 mon., these doctor's are having me get bloodwork and if ANYTHING even slightly abnormal comes up on them, they send me back in for even more bloodwork.  The other day, they called me up wanting me to get another bone densitometry and I told them to wait until the fall.  I don't want to go through a whole huge workup trying to have them make me diagnosed with IR, just to end up having something else for them to call me in for constantly.  No thanks.  I'll take my chances.  I already get ultrasounded or MRI's every 6 mon., if any Liver abnormality i.e. Liver CA shows up, it will be caught early.  I am not cirrhotic yet, so I'm not going to get into all this worrying.  Thanks for letting me get on my soapbox!   Susan400

[Cory255]

If anything is going to increase your odds of SVR it is worth looking into...

Looks like you're about to share the HOMA equation...

Get it out in the open...  I'd like to give my teacher and scholar Co, props for sharing this equation with me.  

Get your fasting blood sugar and fasting insulin tested first.

Take your results (fasting blood sugar & fasting insulin) and multiply,,, and then divide by 22.5.  

The higher the HOMA, the more insulin resistant you are and the more SVR drops.

If you're results are less than 2... SVR 60.5%

If between 2 & 4... SVR 40%

If higher than 4... SVR 20%

[bandman54]

I am skinny an have IR.

A1c is normal

You need to find a Homa caculator.
Have your fasting glucose and fasting insulin
tested and then calculate your Homa.
I am sure someone here can post the
formula , if not I will post later.

I your glucose is nearly always over 100
there is a chance you are IR

I finally got my glucose under 100 but insulin
is 16. So homa score is 3.34

too high!

Bandman

[Cory255]

I agree, you should get this checked out.  

As far as I know, fasting insulin and fasting blood sugar can be done with the same test and ordered by any Doctor.  

It is recommeded to change your lifestyle by exercising and eating right first.