Risk of Liver Cancer Low in Patients With Cirrhosis
People with cirrhosis have an estimated cumulative 10-year incidence of hepatocellular carcinoma (HCC) of 4% or lower, according to a new study. Cumulative incidence varies with etiology, where people with alcohol or cryptogenic cirrhosis have the lowest risk for HCC.
“The low incidence of liver cancer is important,” said lead study author Joe West, PhD, of the division of epidemiology and public health at the University of Nottingham in the UK. “First, the risks can be communicated to patients, and second, decisions about whether to do surveillance for this cancer in people with cirrhosis can be informed by our findings.”
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The researchers identified subjects with hepatic cirrhosis from the UK’s General Practice Research Database (1987-2006) and obtained diagnoses of HCC from linked national cancer registries (1971-2006). They used Cox proportional hazards regression to estimate hazard ratios and estimated the predicted 10-year cumulative incidence of HCC for each etiology of cirrhosis while accounting for competing risks of death from any cause and liver transplant.
Among 3107 people with cirrhosis, the adjusted relative risk of HCC was increased 2- to 3-fold among people with viral and autoimmune/metabolic etiologies, compared to those with alcohol-associated cirrhosis. The 10-year predicted cumulative incidence estimates of HCC for each etiology were alcohol, 1.2%; chronic viral hepatitis, 4.0%; autoimmune or metabolic disease, 3.2%; and cryptogenic, 1.1%.
“Primary care providers now have good information about this risk that they can communicate and act on as necessary,” Dr West said.
The researchers said their study contributes important information to the ongoing debate about the utility and implementation of surveillance for HCC among people with cirrhosis. They plan to continue research in this area.
—Mike Bederka
Reference:
West J, Card TR, Aithal GP, Fleming KM. Risk of hepatocellular carcinoma among individuals with different aetiologies of cirrhosis: a population-based cohort study [published online Feb 1, 2017]. Aliment Pharmacol Ther. doi: 10.1111/apt.13961.