Estimate of hepatocellular carcinoma incidence in patients with alcoholic cirrhosis (original) (raw)

2018, Journal of Hepatology

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.