Endocrine Abstracts

Introduction: Hepatocellular carcinoma (HCC) is the first cause of death in patients with cirrhosis, with an incidence of 3–5% per year and a survival of 0–10% 5 years after the diagnosis. Major risk factors for HCC are HCV, HBV infection and alcohol, while a specific cause is not identifiable in 5–30% of cases. Several studies have shown a strong association between metabolic syndrome (MS), characterized by insulin-resistance (IR) and central obesity, and HCC; In patients with liver cirrhosis, however, diagnosis of MS can be very difficult because of the presence of several confounders as ascites and edema, which invalidate the use of BMI and waist circumference, the use of diuretics and beta-blockers, which hide the presence of hypertension, altered glucose and cholesterol metabolism. For this reasons the availability of mathematical indices is fundamental to recognize insulin-resistant people in this population.

Aim of the study: Evaluate, in cirrhotic patients in waiting list for liver transplantation, the presence of insulin resistance and its association with increased risk of HCC.

Materials and methods: One hundred and four patients 33M/71F, age 53±9, with liver cirrhosis, 30 of them affected by HCC. They underwent an anthropometric and metabolic evaluation and an OGTT. Insulin resistance was assessed with HOMA, OGIS-2 h and MATSUDA index. Regarding to HOMA, we used a cut off of 3 to identify insulin-resistant patients.

Results: Prevalence of HCC was significantly higher in cirrhotic patients with insulin-resistance assessed by HOMA, vs cirrhotic patients without insulin-resistance (39% vs 16%, P<0.05). In our population there were no significant differences in OGIS and MATSUDA indices.

Conclusions: In patients with end-stage liver disease, HOMA, a reliable index to identify insulin-resistant patients, allows to characterize a class of patients at highest risk of developing HCC.