Cirrhosis Doesn't Lead to Liver Cancer as Often as Thought

Researchers found that, at most, 4% of people with cirrhosis will develop HCC.

Cirrhosis has long been thought to be a major risk factor for hepatocellular carcinoma (HCC), the most common form of liver cancer. Cirrhosis also limits cancer treatments. But a new study finds the cancer incidence in people with cirrhosis is lower than thought—at most, about 4%. Noting that there is little research that actually supports the cirrhosis-cancer link, researchers from The University of Nottingham in the United Kingdom set out to identify the cumulative incidence of HCC in people with cirrhosis.

Joe West, PhD, and colleagues gathered data from 3,107 patients with cirrhosis from the UK’s General Practice Research Database (1987 to 2006). HCC diagnoses were collected from linked national cancer registries (1971 to 2006). Using a Cox proportional hazards regression model, the researchers were able to estimate hazard ratios and predict 10-year cumulative incidence of HCC.

Just over half of the patients were male and ages ranged from 18 to 65. They had various etiologies which led to cirrhosis:

  • Alcohol: 1,743 patients (56%)
  • Cryptogenic: 647 patients (21%)
  • Chronic viral hepatitis: 374 patients (12%)
  • Autoimmune or metabolic disease: 342 (11%)

Out of all the patients, 51 developed HCC within a decade. Broken down by liver condition, 1.2% of those with alcoholic cirrhosis and 1.1% of those with cirrhosis of unknown cause developed HCC.

“This very low incidence of HCC occurrence in people with cirrhosis caused by alcohol or of unknown origin suggests that surveillance for HCC among these groups is likely to benefit patients little,” West, professor epidemiology at the university’s School of Medicine, said in a news release.

Results showed that, “the adjusted relative risk of HCC was increased two-fold to three-fold among people with viral and autoimmune/metabolic etiologies, compared to those with alcohol-associated cirrhosis,” the authors wrote in the journal Alimentary Pharmacology and Therapeutics.

Further findings indicated that 1.1% of patients with cryptogenic, 3.2% with autoimmune or metabolic disease, and 4% with chronic viral hepatitis developed HCC within 10 years.

Looking at the overall population—making up 12,977 person years—the HCC rate was 3.9 per 1,000 person years (0.4% annually).

“As surveillance incurs substantial cost, it is therefore unlikely to represent value for money for the NHS,” West concluded. “There may well be other ways of spending this money that would benefit patients far more.”

The study, “Risk of hepatocellular carcinoma among individuals with different etiologies of cirrhosis: a population-based cohort study,” was published in Alimentary Pharmacology and Therapeutics. The news release was provided by The University of Nottingham.

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