The risk for hepatocellular carcinoma was low among patients with cirrhosis, with a 10-year incidence of 4% or lower, according to the results of a U.K. population-based cohort study.
While low overall, investigators found the incidence of HCC was highest among patients with cirrhosis due to chronic viral hepatitis compared with other etiologies.
“This very low incidence of HCC occurrence in people with cirrhosis caused by alcohol or of unknown origin suggests that surveillance for HCC among these groups is likely to benefit patients little,” Joe West, PhD, of the division of epidemiology and public health at the University of Nottingham in the U.K., said in a press release. “As surveillance incurs substantial cost, it is therefore unlikely to represent value for money for the NHS. There may well be other ways of spending this money that would benefit patients far more.”
West and colleagues identified 3,107 patients diagnosed with cirrhosis between 1987 and 2006 using the U.K.’s General Practice Research Database, and assessed the incidence of HCC using linked national cancer registry data spanning 1971 to 2006. The patients contributed 12,977 person-years to the study, 56% had alcoholic cirrhosis, 12% had cirrhosis due to chronic viral hepatitis, 11% had cirrhosis due to autoimmune or metabolic disease, and 21% had cirrhosis due to an unknown cause.
Fifty-one incident cases of HCC occurred, corresponding to an incidence rate of 3.9 per 1,000 person-years. Absolute rates of HCC, “as expected … were higher in men compared to women, at older ages and among those with a chronic viral etiology,” the researchers wrote.
After adjusting for confounders, the adjusted relative risk for HCC was three times higher in patients with a chronic viral etiology compared with those with an alcohol-related etiology (HR = 3.22; 95% CI, 1.56-6.65).
“Those with metabolic or autoimmune diseases were also at increased risk compared to the alcoholic group, whereas those with the assignation of cryptogenic cirrhosis had a similar incidence of HCC to the alcohol group,” the researchers wrote.
Finally, they estimated that 10-year cumulative HCC incidences were 1.2% for alcoholic cirrhosis, 4% for cirrhosis due to chronic viral hepatitis, 3.2% for cirrhosis related to autoimmune or metabolic disease, and 1.1% for cirrhosis due to an unknown cause.
“Although there may be particular patients with combinations of risk factors where surveillance is warranted, our results imply that universal surveillance should not be undertaken on the basis of alcoholic etiology or in cryptogenic cirrhosis and is likely to be of debatable value in autoimmune and metabolic causes of cirrhosis,” they concluded. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.