Incidence and Risk Factors for Hepatocellular Carcinoma in Primary Biliary Cirrhosis (original) (raw)

Abstract

The incidence, risk factors, and clinical features of hepatocellular carcinoma (HCC) in primary biliary cirrhosis (PBC) have been a long-standing subject of interest. We took advantage of a large cohort of 1865 well-defined Chinese patients with PBC for whom follow-up was conducted for up to 20 years to study the incidence of HCC. Our goal was to address the incidence and prevalence of HCC in PBC and the risk factors, including hepatitis B virus (HBV) infection, and finally to compare the tumor characteristics of PBC-related HCC, including size, location, mortality, and long-term outcomes, to that of HBV-related HCC. In this cohort, HCC occurred in 70 of 1865 PBC patients with a prevalence of 3.75 % and an incidence of 0.66 cases per 100 patient-years. The 5- and 10-year cumulative incidences were 2.6 % (95 % confidence interval (CI) 1.8–3.4) and 8.9 % (95 % CI 5.5–12.3), respectively. Age >54 years (odds ratio [OR] = 5.5, 95 % CI 3.0–10.1, p = 0.001), male sex (OR = 2.2, 95 % CI 1.2–4.0, p = 0.001), co-existence of diabetes mellitus (DM) (OR = 3.1, 95 % CI 1.6–6.2, p = 0.002), and previous HBV infection (OR = 6.6, 95 % CI 3.7–11.9, p = 0.001) were independently associated with the development of HCC. The tumor size, number, location, and 5-year survival were not significantly different in PBC-related HCC compared to HBV-related HCC. Alpha-fetoprotein was elevated in only 20 % of the cases with PBC-related HCC. Although HCC was uncommon, occurring in fewer than 5 % of patients, the risk is significantly increased by age, sex, DM, and past HBV infection.

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Abbreviations

PBC:

Primary biliary cirrhosis

UDCA:

Ursodeoxycholic acid

LT:

Liver transplantation

HCC:

Hepatocellular carcinoma

CLDs:

Chronic liver diseases

CHB:

Chronic hepatitis B

CHC:

Chronic hepatitis C

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

AMA:

Anti-mitochondrial antibodies

ALP:

Alkaline phosphatase

SR:

Surgical resection

PLATs:

Percutaneous local ablative therapies

TACE:

Transarterial chemoembolization

OS:

Overall survival

DM:

Diabetes mellitus

ANA:

Anti-nuclear antibodies

Aabs:

Autoantibodies

PDC-E2:

E2 subunit of the pyruvate dehydrogenase complex

OGDC-E2:

E2 subunit of the oxo-glutarate dehydrogenase complex

BCOADC-E2:

E2 subunit of the branched chain 2-oxo acid dehydrogenase complex

SP100:

Speckled protein 100 kDa

GP210:

Glycoprotein 210 kDa

AFP:

Alpha-fetoprotein

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Acknowledgments

We thank Miss Cuihong Zhang and staff for their assistance with data collection. This work was supported by the National Science Foundation of China (No. 81272330 and No. 81202362) and the Outstanding Medical Talents Foundation of PLA (No. 04J020).

Conflict of Interest

None

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Author notes

Authors and Affiliations

  1. Center of Therapeutic Research for Hepatocellular Carcinoma, The 302 Hospital, 100 Xi Si Huan Middle Road, 100039, Beijing, China
    Guanghua Rong, Hong Wang, Chunping Wang, Yinying Lu, Zhen Zeng, Jianhui Qu, Min Lou, Yan Chen, Linjing An & Yongping Yang
  2. Division of Gastroenterology and Hepatology, University of California Davis, Davis, CA, 95616, USA
    Christopher L. Bowlus
  3. Division of Rheumatology, Allergy, and Clinical Immunology, School of Medicine, Genome and Biomedical Sciences Facility, University of California Davis, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
    M. Eric Gershwin

Authors

  1. Guanghua Rong
  2. Hong Wang
  3. Christopher L. Bowlus
  4. Chunping Wang
  5. Yinying Lu
  6. Zhen Zeng
  7. Jianhui Qu
  8. Min Lou
  9. Yan Chen
  10. Linjing An
  11. Yongping Yang
  12. M. Eric Gershwin

Corresponding authors

Correspondence toYongping Yang or M. Eric Gershwin.

Additional information

Guanghua Rong and Hong Wang contributed equally to this work.

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Rong, G., Wang, H., Bowlus, C.L. et al. Incidence and Risk Factors for Hepatocellular Carcinoma in Primary Biliary Cirrhosis.Clinic Rev Allerg Immunol 48, 132–141 (2015). https://doi.org/10.1007/s12016-015-8483-x

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