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Elevated testosterone increases risk of hepatocellular carcinoma in men with chronic hepatitis B and diabetes mellitus
Author(s) -
Yip Terry CheukFung,
Wong Grace LaiHung,
Chan Henry LikYuen,
Tse YeeKit,
Liang Lilian Yan,
Hui Vicki WingKi,
Lee Hye Won,
Lui Grace ChungYan,
Kong Alice PikShan,
Wong Vincent WaiSun
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15079
Subject(s) - medicine , hepatocellular carcinoma , hazard ratio , interquartile range , gastroenterology , diabetes mellitus , risk factor , hepatitis c , incidence (geometry) , testosterone (patch) , cumulative incidence , retrospective cohort study , confidence interval , cohort , endocrinology , physics , optics
Background and Aim Male sex is a risk factor for hepatocellular carcinoma (HCC). Diabetes mellitus (DM) is associated with a doubled risk of HCC in patients with chronic hepatitis B (CHB). We examined the relationship between serum total testosterone and HCC risk in male CHB patients with DM. Methods We performed a retrospective cohort study of male CHB patients with DM between 2000 and 2017 using a territory‐wide electronic health‐care database in Hong Kong. DM was defined by use of anti‐diabetic medications, hemoglobin A 1c ≥ 6.5%, and/or fasting glucose ≥ 7 mmol/L in two measurements or ≥ 11.1 mmol/L in one measurement. Results Of 928 male CHB patients with DM, 83 (8.9%) developed HCC at a median (interquartile range) of 10.7 (6.1–14.6) years. Higher testosterone was associated with an elevated risk of HCC (adjusted hazard ratio [aHR] per 1 SD increase 1.23, 95% confidence interval [CI] 1.03–1.46, P = 0.024). The upper tertile of testosterone (aHR 1.86, 95% CI 1.02–3.39, P = 0.043), but not middle tertile (aHR 0.84, 95% CI 0.41–1.69 P = 0.620), was associated with a higher risk of HCC than the lower tertile. The cumulative incidence (95% CI) of HCC at 5, 10, and 15 years was 4.4% (2.5–7.2%), 12.4% (8.7–16.7%), and 19.1% (14.2–24.5%), respectively, in patients in the upper tertile of testosterone. By subgroup analysis, the association between testosterone and HCC was stronger in patients aged ≥ 50 years and those not receiving antiviral therapy. Conclusion Higher serum testosterone is associated with a higher incidence of HCC in male CHB patients with DM.