Risk of hepatocellular carcinoma in Danish outpatients with alcohol-related cirrhosis

Jepsen, Peter; Kraglund, Frederik; West, Joe; Villadsen, Gerda E.; Toft S�rensen, Henrik ; Vilstrup, Hendrik

Abstract

Background and aims: Accurate estimates of the risk of hepatocellular carcinoma (HCC) in patients with cirrhosis are important for clinical decisions about HCC surveillance. We described HCC risk among outpatients with alcoholic cirrhosis and contrasted the risk of death from HCC with the risk of death from variceal bleeding or trauma.

Methods: This was a nationwide, registry-based historical cohort study between 2006 and 2018. We included all Danish outpatients with a hospital diagnosis of alcoholic cirrhosis, except those with cancer, those with chronic viral hepatitis or autoimmune liver disease, and those older than 80 years. We followed them through 2018 and described the cumulative risk of HCC and the cumulative risk of death from HCC, variceal bleeding, or trauma.

Results: Of the 4553 included patients, 181 developed HCC and 2274 died. The cumulative risk of HCC was 0.9% (95% confidence interval [CI] 0.7 to 1.3) after 1 year, 3.6% (95% CI 3.0 to 4.2) after 5 years, and 6.0% (95% CI 5.1 to 7.0) after 10 years, or approximately 0.7% per year. Male gender, older age, and decompensated cirrhosis predicted a higher HCC risk. After 10 years, 6.9% of deaths in the cohort could be attributed to HCC, whereas 6.5% could be attributed to variceal bleeding, and 5.0% to trauma.

Conclusions: In 2006–2018, Danish outpatients with alcoholic cirrhosis had an HCC risk of 0.7% per year, and they were nearly as likely to die from variceal bleeding or from trauma as from HCC. The implications are that many potentially harmful examinations are required for every HCC found through surveillance, so interventions targeting the prevention of other causes of death might be more cost-effective.

• Journal Article Type: Article
• Acceptance Date: May 26, 2020
• Online Publication Date: Jun 4, 2020
• Publication Date: Nov 1, 2020
• Deposit Date: Jun 16, 2020
• Publicly Available Date: Jun 5, 2021
• Journal: Journal of Hepatology
• Print ISSN: 0168-8278
• Electronic ISSN: 1600-0641
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 73
• Issue: 5
• Pages: 1030-1036
• DOI: https://doi.org/10.1016/j.jhep.2020.05.043
• Keywords: Liver cirrhosis, Primary liver cancer, Prognosis, Screening, Epidemiology
• Public URL: https://nottingham-repository.worktribe.com/output/4659191
• Publisher URL: https://www.journal-of-hepatology.eu/article/S0168-8278(20)30363-9/fulltext