Disclosures: Hagström reports receiving consulting fees Gilead and Novo Nordisk, and research grants from Astra Zeneca, Gilead and Intercept. He also reports serving on the advisory board at Bristol Myers Squibb and Gilead. Please see the full study for all other authors’ relevant financial disclosures.
January 07, 2021
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Alcohol-related liver disease increases risk for cancer

Disclosures: Hagström reports receiving consulting fees Gilead and Novo Nordisk, and research grants from Astra Zeneca, Gilead and Intercept. He also reports serving on the advisory board at Bristol Myers Squibb and Gilead. Please see the full study for all other authors’ relevant financial disclosures.
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Patients with alcohol-related liver disease who survive for at least 1 year after diagnosis are at increased risk for cancer, according to study results.

Hannes Hagström, of the division of hepatology at Karolinska University Hospital in Sweden, and colleagues wrote that the association between incident cancer and alcohol-related liver disease (ALD) is not well understood, because patients with ALD are already at increased risk for death and liver-related endpoints.

“Given that alcohol per se is considered a risk factor for several cancers including liver, kidney, breast, colorectal and others, it is reasonable to believe that the risk of these cancers would be high also in persons with a diagnosis of ALD,” they wrote.

Researchers explored this potential association by comparing a cohort of 3,410 patients with a diagnosis of ALD and an available liver biopsy with a matched reference population. They defined exposure and outcome status using administrative coding from national registers, as well as liver biopsy data.

Median age of patients with ALD included in the study was 58.2 years, 67% were men and 60% had cirrhosis.

Hagström and colleagues found that ALD was not associated with cancer in general. However, the risk increased among patients who survived for at least 1 year (subdistribution HR = 1.19; 95% CI, 1.08-1.32), and the risk for liver cancer was increased (sHR = 12.8; 95% CI, 9.38-17.45).

Additionally, researchers found that the incidence of hepatocellular carcinoma among patients with ALD and cirrhosis was 8.6 cases per 1,000 person-years, which corresponds with an incidence rate of 5% after 10 years.

“Persons with biopsy-proven ALD are at an elevated risk of developing incident cancer, especially for HCC, if they survive the first period after diagnosis,” Hagström and colleagues wrote. “However, because the risk of non-cancer death is considerable in this population, most persons will die before they can develop cancer. The risk of HCC in our study was lower than in several previous studies, which calls into question the use of routine HCC surveillance in all persons with ALD cirrhosis and supports individualized decision-making.”