Observational studyJournal of Korean medical science2026
Insulin Resistance and Hepatocellular Carcinoma Development in Chronic Hepatitis B Patients Under Antiviral Therapy.
Observational study in Journal of Korean medical science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHepatocellular carcinoma (HCC) remains a significant concern in patients with liver cirrhosis due to chronic hepatitis B virus (HBV) infection, even among those who achieve a virological response with antiviral therapy. This study aimed to evaluate whether insulin resistance (IR), assessed using the Homeostatic Model Assessment 2 for Insulin Resistance (HOMA2-IR) index, can serve as a surrogate marker for stratifying HCC risk in this population.
methodsIn this multicenter prospective cohort study, 334 patients with HBV-related cirrhosis who achieved virological response to nucleos(t)ide analogue therapy were enrolled. The primary outcome was the incidence of HCC during follow-up. Baseline HOMA2-IR was calculated using serum C-peptide and fasting glucose levels.
resultsDuring a median follow-up of 7.45 years (range, 0.5-8.9 years), 62 patients (18.6%) developed HCC. In a fully adjusted Cox proportional hazards model, each unit increase in HOMA2-IR was associated with a higher risk of HCC (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.16-2.04). Patients with HOMA2-IR ≥ 2.3 had a significantly higher 5-year cumulative incidence of HCC compared to those with HOMA2-IR < 2.3 (30.6% vs. 12.3%; adjusted HR, 2.62; 95% CI, 1.40-4.91). The association between HOMA2-IR and HCC risk was consistent across subgroups, including those with and without metabolic comorbidities such as obesity, diabetes, hypertension, or dyslipidemia.
conclusionIR, as measured by HOMA2-IR, independently predicted HCC development in cirrhotic patients with chronic HBV infection. HOMA2-IR may serve as a useful surrogate marker for identifying high-risk individuals. Intervention trials are warranted to determine whether reducing HOMA2-IR can lower HCC risk in this population.
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