Liver cancer is one of the most common and lethal cancer worldwide as well as in Korea. Chronic infection with hepatitis B or C virus and alcoholic cirrhosis are well known for major risk factors for liver cancer. However there are not enough evidences for other risk factors, such as diabetes and tobacco smoking, and their interactions. These factors could be clues for cryptogenic liver cancer, which is not associated with chronic viral hepatitis and alcoholic cirrhosis. The aim of this study was to evaluate the association between blood glucose level and liver cancer development in Korea. A total of 16,542 healthy participants were enrolled in Korean Multi-Center Cancer Cohort (KMCC) between 1993 and 2002. As of December 2002, 51 incident liver cancer cases were identified from Korea National Cancer Incidence Data Base. All participants completed a baseline questionnaire about lifestyle characteristics and serum level of glucose was measured at enrollment. Relative risks for each risk factor were estimated using Cox proportional hazard regression model and adjusted for age, gender, smoking history, alcohol consumption and hepatitis B antigen(HBsAg) seropositivity. Relative risks of serum glucose were 1.79 (95% CI 0.52-6.16) for the category of 110 to 125 mg/dL and 3.63 (95% CI 1.48-8.86) for the category of 126 mg/dL or greater(P for trend = 0.007), as compared to the category of less than 110 mg/dL. High level of serum glucose (126 mg/dL or greater) and smoking history synergistically elevated the risk of liver cancer significantly(RR 5.4, 95% CI 1.3-23.4). In subgroup analysis among those who were HBsAg seronegative and never drinkers, relative risk for serum glucose was 8.42 (95% CI 1.17-60.41) for the category of 126 mg/dL or greater. This study demonstrates that high level of serum glucose might raise the risk of liver cancer in Korea. The association was independent of hepatitis infection and drinking history. This study suggests that insulin resistance and glucose intolerance could be associated with carcinogenesis mechanism of liver cancer.
[Proc Amer Assoc Cancer Res, Volume 47, 2006]