High prevalence of multinodular hepatocellular carcinoma in patients with cirrhosis attributable to multiple risk factors (original) (raw)
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Estimate of hepatocellular carcinoma incidence in patients with alcoholic cirrhosis
Journal of Hepatology, 2018
Background and aims: The CIRRAL cohort aimed to assess the burden of complications in patients with alcoholic cirrhosis, particularly the occurrence of hepatocellular carcinoma (HCC). Patients with biopsy-proven compensated alcoholic cirrhosis were included then prospectively followed. The main end point was the incidence of HCC. Secondary outcomes were incidence of hepatic focal lesions, overall survival (OS), liver-related mortality and event-free survival (EFS). Results: From October 2010 to April 2016, 652 patients were included in 22 French and Belgian centers. During follow-up (median 29 months), HCC was diagnosed in 43 patients. With the limitation derived from the uncertainty of consecutive patients' inclusion and from a sizable proportion of dropouts (153/652), the incidence of HCC was 2.9 per 100 patients-year, and 1-and 2-year cumulative incidences of 1.8% and 5.2%, respectively. Although HCC fulfilled the Milan criteria in 33 cases (77%), only 24 patients (56%) underwent a curative treatment. An explorative prognostic analysis showed that age, male gender, baseline AFP, bilirubin and prothrombin were significantly associated with the risk of HCC occurrence. Among 73 deaths, 61 had recorded cause and 27 were directely attributable to liver disease. At 2 years, OS, EFS and cumulative incidences of liver-related deaths were 93% (95%CI: 90.5-95.4), 80.3% (95%CI: 76.9-83.9), and 3.2% (95%CI: 1.6-4.8) respectively. Conclusion: This large prospective cohort incompletely representative of the whole population with alcoholic cirrhosis showed: a) an annual incidence of HCC up to 2.9 per 100 patients-year, suggesting that surveillance might be cost effective in these patients; b) a high proportion of HCC detected within the Milan criteria, but only one-half of detected HCC cases were referred for curative treatments; c) a 2-year mortality up to 7%. Lay Summary Cirrhosis is a risk factor for primary liver cancer leading to recommandations for periodical screening. However, in case of an alcoholic origin of the liver disease, the rational of periodical screening for HCC is controversial, as registry and databased studies have suggested low incidence of HCC in these patients and a high competitive mortality. With the limitation of a possible selection and attrition bias, this large cohort of unambiguously biopsy proven alcoholic cirrhosis prospectively screened for HCC demonstrated a high annual incidence of HCC (2.9%) and a high percentage of small cancers theorically eligible for curative treatment, suggesting that alcoholic origin of the disease shouldn't rule out patiens for screening.
BMC Cancer, 2007
Aims: Hepatocellular carcinoma (HCC) represents O90% of primary liver neoplasms and develops mainly in patients with liver cirrhosis. Risk factor identification for the development of HCC in patients with cirrhosis possesses great clinical relevance due to its high incidence and poor prognosis when detected at advanced stages. The aim of this study was to identify HCC development-associated risk factors in a cohort of patients with hepatitis virus-related chronic liver disease and cirrhosis. Materials and methods: Patients with a diagnosis of hepatitis virus-related cirrhosis between January 1980 and January 2000 were included. Patients were followed with an abdominal ultrasound and the determination of alpha-fetoprotein levels, a physical examination, and routine biochemical tests every 3e6 months. The end point of the study was defined as the development of HCC. Liver histology was evaluated according to the French METAVIR Cooperative Study Group (METAVIR) score. Results: Two hundred and eighty-two patients met the inclusion criteria; most of these (86%) had a serologic diagnosis of hepatitis C virus, and only 14% had hepatitis B virus at the time of the diagnosis of cirrhosis, whereas 56 and 37% were classified as Child A and B, respectively, and only 7% as Child C. Histological activity was mild in 59% of patients, and moderate and severe in 41%. The mean annual incidence was 1.87%, and 22 and 35% of patients developed HCC at 10 and 15 years of follow-up, respectively. The diagnosis of HCC was made by histopathology in 37% and by tumoural lesionassociated alpha-fetoprotein elevation confirmed by imaging studies in 63%. In multivariate analysis, we found three variables associated with HCC: moderate to severe histological activity; a platelet count !105 3 10 3 /mm 3 , and alphafetoprotein O5 ng/ml. The patients were divided into two groups according to regression coefficient: low and high risk; patients assigned to the low-risk group showed 5-, 10-and 15-year HCC incidences of 3.4, 6.4 and 6.4%, respectively, in contrast to patients from the high-risk group, who showed incidences of 17.8, 33.5 and 56.8%, respectively. Conclusions: We found three HCC-associated variables: histological activity, platelet count and alpha-fetoprotein levels. Patients considered as high risk for developing HCC must be considered candidates for closer follow-up. Rodríguez-Díaz,
Progression of liver disease and associated risk of hepatocellular carcinoma
Hepatoma Research, 2024
Hepatocellular carcinoma (HCC) is the primary liver cancer type, often seen in individuals with chronic liver disease. Once the patient progresses to the cirrhotic stage, the annual incidence of HCC is approximately 2%-4%. As it exceeds the minimum threshold of 1.0%-1.5% per year, HCC screening every 6 months through abdominal ultrasound is indicated in the cirrhotic population. While the incidence of viral hepatitis-associated HCC is decreasing, there is a notable rise of HCC associated with metabolic dysfunction-related steatotic liver disease and alcohol-related liver disease, particularly in high-income countries. The most effective approach for oncological prevention remains addressing the cause of liver disease. The indications for HCC screening in patients without cirrhosis depend on the etiology of liver disease and the stage of fibrosis, assessed by liver biopsy or noninvasive tests such as FIB-4 or transient elastography. However, clear recommendations for HCC screening in patients without cirrhosis and for the different etiologies are currently unavailable. Research efforts should focus on identifying markers, or combinations thereof, to provide a more accurate estimate of HCC occurrence. Such advancements would enable the effective targeting of populations at the highest risk of HCC and the establishment of the correct timing to start the screening.
Hepatocellular carcinoma in patients without cirrhosis: relevance and clinical characteristics
Hepatoma Research, 2018
Aim: The present study evaluated the frequency of hepatocellular carcinoma (HCC) in patients without cirrhosis. Methods: HCC patients were recruited from two reference centers for liver disease in Northeast Brazil from 2010 to 2016. The diagnosis of HCC and cirrhosis was based on international criteria. Results: A total of 169 patients were included, and 16% (27) of the patients did not have hepatocellular carcinoma in non-cirrhosis (HCC-NC). The mean age of HCC-NC was 64.4 ± 11.3 years, and 74.1% of the patients were male. The main risk factors were hepatitis C virus (HCV) in 29.6% (8), nonalcoholic steatohepatitis (NASH) in 14.8% (4) and hepatitis B virus (HBV) in 11.1% (3). Histological HCC diagnosis was performed in 81.5% (22) of the patients, and in 18.5% (5) of these patients, the diagnosis was performed by ultrasonography, computed tomography or nuclear magnetic resonance imaging methods. Single nodules were found in 56% of HCC-NC (14) when assessed by imaging methods. Conclusion: The frequency of HCC-NC was elevated and more common in males. HCV, NASH and HBV were the most frequent risk factors. These data contribute to discussion on future protocols and criteria for the early diagnosis and treatment of HCC in patients with chronic liver disease without cirrhosis.
Etiology of hepatocellular carcinoma in Italian patients with and without cirrhosis
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2000
We performed a case-control study to assess the role of hepatitis B virus (HBV), hepatitis C virus (HCV), GB virus C/hepatitis G virus (HGV), TT virus, alcohol intake, and tobacco smoking as risk factors for hepatocellular carcinoma (HCC) in the presence or absence of cirrhosis. We prospectively recruited 174 patients with a first diagnosis of HCC admitted to the main hospitals in Brescia, North Italy. On the basis of histological, clinical, and radiological criteria, the presence of cirrhosis was established in 142 cases, excluded in 21 cases, and remained undefined in 11 cases. Among the HCC cases without cirrhosis, a histological picture of normal liver was found in a single patient, chronic viral hepatitis was found in 11 patients, alcoholic hepatitis was found in 5 patients, nonspecific reactive hepatitis was found in 3 patients, and hemochromatosis was found in 1 patient. As controls, we also included 610 subjects unaffected by hepatic diseases and admitted to the same hospita...
Digestive and Liver Disease, 2011
Background: The aetiological factors of hepatocellular carcinoma may vary over time. Aims: The study assessed the potential impact of the aetiological factors on the effectiveness of surveillance in real-world patients. Methods: Multicentre, cross-sectional study enrolling consecutive hepatocellular carcinoma cases during a six month period. Results: 1733 cases (1311 prevalent and 422 incident) were recruited (mean age 68.6 years; 46.1% cases over 70 years; 73.9% males; 95.3% with cirrhosis); 63.0% were hepatitis C virus positive and 23.7% were virus negative. Amongst incident HCCs, 34.5% were single ≤3 cm and 54.4% met the Milan criteria; 61.6% were diagnosed during surveillance; virus negative patients showed the lowest rate of surveillance (51.0%). Surveillance was an independent predictor of detecting single HCCs ≤2 cm (O.R. = 5.4; 95% C.I. = 2.4-12.4) or HCCs meeting the Milan criteria (O.R. = 3.1; 95% C.I. = 1.9-5.2). Compared with an earlier Italian survey, there was a higher proportion of elderly subjects (P < 0.01), Child-Pugh class A cases (P < 0.01), of virus-negative patients (P < 0.01) and with single tumours ≤3 cm (P < 0.01) and a lower prevalence of hepatitis C virus positive individuals (P < 0.01). Conclusion: HCC is characterised by a growing prevalence of elderly patients and cases unrelated to hepatitis virus infections. The application of surveillance must be implemented, particularly amongst non-viral patients.