In the Journals Plus

Alcohol-related liver cancer has worse prognosis

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March 28, 2018

Charlotte E. Costentin

Patients with alcohol-related hepatocellular carcinoma appeared to have worse prognosis than those with nonalcohol-related disease, according to study findings published in Cancer.

However, OS did not differ between the groups when tumor stage at diagnosis was the same, which suggests that stage of diagnosis is a significant driver of survival.

“Our results are important because they advocate for implementing effective screening programs (ie, biannual ultrasound imaging) to increase the rates of early diagnosis and insuring access to alcoholism treatment to improve liver function,” Charlotte E. Costentin, MD, from Hôpital Henri-Mondor in France, told HemOnc Today. “Both interventions should translate into better outcomes among patients with alcohol-related liver cancer.”

HCC is accountable for more than 90% of all primary liver cancers. Between 25% and 30% of cases in the United States are related to alcohol; however, rates may be higher because alcohol consumption is often underreported.

Previous research showed etiology impacts tumor stage at diagnosis and that alcohol-related HCC is often diagnosed at a later stage.

Costentin and colleagues evaluated data from 1,207 patients with newly diagnosed HCC to compare clinical features at diagnosis, therapeutic allocations and outcomes between those with and without alcohol-related disease.

Researchers excluded patients with mixed causes of liver disease. The analysis included 894 patients, of whom 582 had alcohol-related HCC.

Macrovascular invasion (30.4% vs 23.7%; P = .03) and diffuse HCC (18.3% vs 11.1%; P = .006) occurred more frequently in the alcohol-related disease group.

At final analysis, 601 patients had died. The lead time-adjusted median OS was 5.7 months (interquartile range [IQR], 1.5-16) among patients with alcohol-related disease and 9.7 months (IQR, 3.2-26.7) among patients with nonalcohol-related disease (P = .0002).

After stratification by Barcelona Clinic Liver Cancer stage, lead time-adjusted survival appeared comparable between both groups.

Patients diagnosed during a cirrhosis follow-up program (n = 199) were more likely to receive intent-to-cure treatments (15.4% vs 37.6%; P < .0001) than those diagnosed incidentally. Further, lead time-adjusted median OS was longer among patients diagnosed with HCC during a cirrhosis follow-up program (11.7 months vs. 5.4 months; P < .0001).

Researchers also split the alcohol-related cohort into two groups, including those who abstained from alcohol (n = 305) — with a median time of abstinence of 12 months (IQR, 3-60) — and those who had not abstained from alcohol (n = 244) at the time of HCC diagnosis. Thirty-three patients with alcohol-related HCC did not have information available on alcohol abstinence and were excluded from this comparison.

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Median OS was 5.8 months among patients who abstained from alcohol and 5 months for patients who did not.

Patients in the nonabstinent group had worse ECOG performance status score (51.7% vs. 39.5%; P = .005) than those who abstained, as well as later stage of HCC at diagnosis per the Barcelona Clinic Liver Cancer scoring system (P = .01) and fewer patients who met Milan criteria for liver transplantation (P = .04).

Patients in the nonabstinent group had fewer HCCs diagnosed during the cirrhosis follow-up program (11.9% vs. 28.4%; P < .0001).

The study results support the idea that efforts should be made to improve screening for cirrhosis and liver cancer, as well as improve access to alcoholism treatment for patients, according to Costentin.

“These interventions should translate into a smaller tumor burden and better liver function at diagnosis and, ultimately, into higher rates of curative treatment and improved prognosis among patients with alcoholic liver disease,” Costentin said. – by Melinda Stevens

 

For more information:

Charlotte E. Costentin, MD , can be reached at charlotte.costentin@aphp.fr.

 

Disclosures: Costentin reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

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