ABSTRACT Background and Aims Liver cancer is concurrently influenced by a number of risk factors, such as chronic viral hepatitis, heavy alcohol use, and metabolic associated conditions. This study aims to examine whether there are interaction patterns among factors associated with liver cancer risk among patients with diabetes. Methods In this retrospective cohort study, patients who received care for type 2 diabetes in general outpatient clinics between 2010 and 2019 were identified using electronic health records of Hong Kong. Patients were followed up until a cancer diagnosis, death, or December 31st, 2019. The interaction patterns among factors associated with liver cancer risk were examined using conditional inference survival tree. Results A total of 1,995 and 1,969 patients with and without liver cancer were included. Chronic viral hepatitis status appeared as most dominant factor in differentiating the risk of liver cancer. In the absence of chronic viral hepatitis, low lipids and elevated ALT were identified as key risk factor in older females (> 63years) and males respectively. Differential thresholds across different age groups in males were found, with a higher threshold for the younger group (39 U/L for ≤ 53years vs 31 U/L for > 53years). Conclusion Chronic viral hepatitis, sex, age, ALT, and lipids appear to exhibit interaction patterns on liver cancer incidence among patients with diabetes, providing potential targets for public health prevention strategies.
Yau et al. (Wed,) studied this question.