Risk of hepatocellular carcinoma among individuals with different aetiologies of cirrhosis: a population‐based cohort study

• Published in: Alimentary pharmacology & therapeutics Vol. 45; no. 7; pp. 983 - 990
• Main Authors: West, J., Card, T. R., Aithal, G. P., Fleming, K. M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-04-2017
• Subjects: Adolescent; Adult; Aged; Alcohol; Alcohols; Carcinoma, Hepatocellular - epidemiology; Carcinoma, Hepatocellular - etiology; Cirrhosis; Cohort analysis; Cohort Studies; Death; Female; Health risk assessment; Hepatitis; Hepatocellular carcinoma; Humans; Incidence; Liver; Liver cancer; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - epidemiology; Liver Neoplasms - epidemiology; Liver Neoplasms - etiology; Liver Transplantation; Male; Metabolism; Middle Aged; Population studies; Population-based studies; Proportional Hazards Models; Risk; Studies; Surveillance; Young Adult; United Kingdom > UK
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.13961

Summary
Background
Among patients with cirrhosis, only those determined to be at risk for hepatocellular carcinoma (HCC) should undergo surveillance. However, little is known about how different aetiologies of cirrhosis affect risk for HCC.
Aim
To quantify the cumulative incidence of HCC among a representative population of people with cirrhosis of the liver of varying aetiology.
Methods
We identified subjects with hepatic cirrhosis from the UK's General Practice Research Database (1987–2006). Diagnoses of HCC were obtained from linked national cancer registries (1971–2006). Cox proportional hazards regression was used to estimate hazard ratios. The predicted 10‐year cumulative incidence of HCC for each aetiology of cirrhosis was estimated while accounting for competing risks of death from any cause and liver transplant.
Results
Among 3107 people with cirrhosis, the adjusted relative risk of HCC was increased twofold to threefold among people with viral and autoimmune/metabolic aetiologies, compared to those with alcohol‐associated cirrhosis. The 10‐year predicted cumulative incidence estimates of HCC for each aetiology were alcohol, 1.2%; chronic viral hepatitis, 4.0%; autoimmune or metabolic disease, 3.2%; and cryptogenic, 1.1%.
Conclusions
In a population‐based study in the UK, people with cirrhosis have an estimated cumulative 10‐year incidence of HCC of 4% or lower. Cumulative incidence varies with aetiology such that individuals with alcohol or cryptogenic cirrhosis have the lowest risk for HCC. These findings provide important information for cost‐effectiveness analyses of HCC surveillance.
Linked ContentThis article is linked to Brennan and Bathgate papers. To view these articles visit https://doi.org/10.1111/apt.14013.