Patients with autoimmune hepatitis-related cirrhosis have an increased risk of developing hepatocellular carcinoma and may benefit from increased monitoring, according to a systematic review published in Clinical Gastroenterology and Hepatology.
“Patients with AIH-related cirrhosis are at an increased risk for HCC. HCC surveillance might be cost effective in this population. On the other hand, AIH patients without cirrhosis at index diagnosis, particularly those identified from general populations, are at an extremely low risk of HCC,” Aylin Tansel, MD, and colleagues wrote.
The researchers accessed the PubMed and EMBASE databases from inception to June 2016 for studies in any language or of any design using a combination of MESH and free text terms for AIH and liver cancer. Twenty-five studies with a total of 6,425 patients met their criteria. The studies were from North America, Europe, Asia and Australia.
The median number of patients was 170 (range, 25-1,721), the median follow-up was 8 years (range, 3.3-16 years), there was a higher proportion of women (range, 61.6-91.7%) and the mean patient age was 46.1 years (range, 36-62 years). Twenty-two studies reported cirrhosis in an average of 32.4% of patients (range, 6.3-100%) and six studies reported concurrent autoimmune diseases in an average of 29.1% of patients.
Sixteen studies reported evidence of cirrhosis at the time of AIH diagnosis. The pooled HCC incidence rate in these patients was 10.07 per 1,000 person-years with low between-study heterogeneity (95% CI, 6.9-14.7; I2 = 29.3%).
Thirteen studies were found that reported on patients with HCC but no evidence of cirrhosis at the time of AIH diagnosis. The pooled HCC incidence rate in these patients was 1.14 per 1,000 person-years (95% CI, 0.6-2.17; I2 = 15.6%).
“Besides cirrhosis, we found several demographic and clinical factors associated with HCC risk,” the researchers wrote. “Older age at AIH diagnosis was associated with risk of HCC. Men with AIH had a slightly higher risk of developing HCC than women, but the difference was not statistically significant, likely due to sample size limitations ... and relatively younger age of men at time of AIH diagnosis compared to women.”
Additionally, the researchers found that Asian populations had the highest incidence of HCC compared with the other continents reviewed in the study. This increased risk, however, may be related to the older mean age of the patients or from other factors such as aflatoxin exposure.
“Collectively, these data support the importance of regular monitoring of disease severity in AIH with initiation of HCC screening in patients who progress to cirrhosis despite medical management,” the researchers wrote. – by Talitha Bennett
Disclosure: The researchers report no relevant financial disclosures.