Yang JD, Ahmed F, Mara KC, et al. - Using Cox proportional hazard analysis, researchers explored the connection between diabetes and hepatocellular carcinoma (HCC) in patients with nonalcoholic steatohepatitis (NASH) cirrhosis in an expanded NASH cirrhosis cohort with a longer follow-up. In addition, they analyzed the link between other metabolic risk factors (BMI, hypertension, and hyperlipidemia) and HCC. Between January 2006 and December 2015, all patients with the diagnosis of NASH cirrhosis seen at Mayo Clinic Rochester were identified. Utilizing the United Network for Organ Sharing (UNOS)/Organ Procurement and Transplantation registry for external validation, all adult liver transplant registrants with NASH between 2004 and 2017 were identified. Of the 354 patients (mean age at cirrhosis evaluation was 62) with NASH cirrhosis at the Mayo Clinic, 253 suffered from diabetes and 145 were male. Thirty patients developed HCC during a median follow-up of 47 months. In patients with NASH cirrhosis, diabetes is related to an increased risk of HCC. Moreover, in multivariable analysis, age and low serum albumin were significantly linked to a heightened risk of developing HCC. Other metabolic risk factors, including BMI, hyperlipidemia, and hypertension, were not related to HCC risk.