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

West, Joe; Card, Timothy R.; Aithal, Guruprasad P.; Fleming, Kate M.

Authors

JOE WEST JOE.WEST@NOTTINGHAM.AC.UK
Professor of Epidemiology

Dr TIM CARD tim.card@nottingham.ac.uk
Clinical Associate Professor

Guruprasad P. Aithal

Kate M. Fleming



Abstract

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 2- to 3-fold 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 Risk of HCC in cirrhosis HCC. These findings provide important information for cost-effectiveness analyses of HCC surveillance.

Journal Article Type Article
Publication Date Apr 30, 2017
Journal Alimentary Pharmacology & Therapeutics
Print ISSN 0269-2813
Electronic ISSN 1365-2036
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 45
Issue 7
APA6 Citation West, J., Card, T. R., Aithal, G. P., & Fleming, K. M. (2017). Risk of hepatocellular carcinoma among individuals with different aetiologies of cirrhosis: a population-based cohort study. Alimentary Pharmacology and Therapeutics, 45(7), https://doi.org/10.1111/apt.13961
DOI https://doi.org/10.1111/apt.13961
Keywords Epidemiology; Cancer; Cirrhosis; Hepatocellular carcinoma; Incidence; Alcohol; Cryptogenic; Chronic viral hepatitis
Publisher URL http://onlinelibrary.wiley.com/doi/10.1111/apt.13961
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf
Additional Information This is the peer reviewed version of the following article: West, J., Card, T. R., Aithal, G. P. and Fleming, K. M. (2017), Risk of hepatocellular carcinoma among individuals with different aetiologies of cirrhosis: a population-based cohort study. Aliment Pharmacol Ther, 45: 983–990. doi:10.1111/apt.13961 which has been published in final form at http://onlinelibrary.wi.../10.1111/apt.13961/full This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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