Annual Incidence of Hepatocellular Carcinoma Among Patients With Alcoholic Cirrhosis and Identification of Risk Groups

Mancebo, Alejo; González-Diéguez, M.L.; Cadahía, Valle; Varela, Marı́a; Pérez, Ramón; Navascués, C.A.; Sotorríos, Nieves G.; Martínez, Maribel; Rodrigo, Luı́s; Rodrı́guez, Manuel

doi:10.1016/j.cgh.2012.09.007

Cited by 139 publications

(101 citation statements)

References 27 publications

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“…25 Furthermore, a previous study showed that age and PLT can be used to categorize subjects with alcoholic cirrhosis into different risk groups for HCC incidence. 26 Although alcohol consumption is well known to be a major risk factor for HCC incidence, 27 there are no current guidelines that recommend HCC screening for habitual drinkers or even heavy alcoholics. According to current guidelines, only once they are diagnosed with LC are they recommended for regular HCC screening.…”

Section: Discussionmentioning

confidence: 99%

Prediction of future hepatocellular carcinoma incidence in moderate to heavy alcohol drinkers with the FIB‐4 liver fibrosis index

Suh

Yun

Park³

et al. 2015

Cancer

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BACKGROUND: Although heavy alcoholics are at heightened risk for hepatocellular carcinoma (HCC), there are no guidelines that recommend HCC screening for heavy alcoholics. This study investigated FIB-4, a noninvasive and easily applicable liver fibrosis index, as a risk factor for HCC incidence among alcohol drinkers without viral hepatitis. METHODS: This retrospective cohort study included 6661 generally healthy adults who were 30 years old or older, did not have chronic viral hepatitis, and visited Seoul National University Hospital for a general, routine health evaluation. The future HCC incidence was determined from National Health Insurance medical service claims data (median follow-up, 6.2 years). RESULTS: With adjustments for age, sex, body mass index, smoking, and alcohol, compared with subjects with FIB-4 values less 1.00, subjects with FIB-4 values greater than or equal to 1.75 and less than 2.10 and subjects with FIB-4 values greater than or equal to 2.10 had adjusted hazard ratios (aHRs) of 5.18 (95% confidence interval [CI], 1.12-24.00) and 13.63 (95% CI, 3.77-49.33), respectively, for HCC incidence. This was heightened in subjects who drank more 30 g of alcohol per day: the aHRs were 8.39 (95% CI, 1.28-54.87) and 16.58 (95% CI, 3.87-71.04), respectively. FIB-4 was shown to have a higher predictive value for HCC incidence than ultrasonographically detected liver cirrhosis (C-index, 0.665 vs 0.527; P 5.044). CON-CLUSIONS: High FIB-4 is a risk factor with a high predictive value for HCC incidence, especially among moderate to heavy alcoholics (>30 g/d). FIB-4 is a readily available and probably cost-effective clinical tool with potential value for identifying subpopulations of alcoholics at particularly high risk who would benefit from regular HCC screening. Further investigations are warranted to validate our results; nonetheless, our study suggests that FIB-4 may be useful in HCC screening among alcoholics. Cancer 2015;121:3818-25.

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Section: Discussionmentioning

confidence: 99%

Prediction of future hepatocellular carcinoma incidence in moderate to heavy alcohol drinkers with the FIB‐4 liver fibrosis index

Suh

Yun

Park³

et al. 2015

Cancer

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“…According to the above mentioned thresholds, patients with cirrhosis are appropriate candidates for a cost-effective surveillance, as the annual incidence of HCC in cirrhotic patients with HCV or HBV infection is 1.5%-4.5% and 2.2%-4.3%, respectively, and it is approximately 2.6% in both alcoholic and non-alcoholic steatohepatitis cirrhosis [14,[45][46][47] . Even cirrhotic patients with genetic hemochromatosis or primary biliary cirrhosis have an HCC risk high enough to implement surveillance, whereas the annual incidence of HCC reported in cirrhotic patients with autoimmune hepatitis is 1.1%, thus questioning the CE of surveillance in this category of patients [48][49][50] .…”

Section: Cirrhosismentioning

confidence: 99%

Surveillance for early diagnosis of hepatocellular carcinoma: How best to do it?

Giannini

Cucchetti

Erroi

et al. 2013

WJG

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Surveillance for hepatocellular carcinoma (HCC) is considered a standard of care for patients with chronic liver disease who are at risk of developing this malignancy. Several studies have shown that surveillance can improve the prognosis of patients diagnosed with HCC through an increased likelihood of application of curative or effective treatments. Repetition of liver ultrasonography (US) every 6 mo is the recommended surveillance program to detect early HCCs, and a positive US has to entrain a well-defined recall policy based on contrast-enhanced, dynamic radiological imaging or biopsy for the diagnosis of HCC. Although HCC fulfills the accepted criteria regarding cost-effective cancer screening and surveillance, the implementation of surveillance in clinical practice is defective and this has a negative impact on the cost-effectiveness of the procedure. Education of both physicians and patients is of paramount importance in order to improve the surveillance application and its benefits in patients at risk of HCC. The promotion of specific educational programs for practitioners, clinicians and patients is instrumental in order to expand the correct use of surveillance in clinical practice and eventually improve HCC prognosis.

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“…Kuper et al [86] reported a relative risk of HCC of 2.4 for alcoholism alone and 22.4 for alcoholic cirrhosis compared to the general population. Several other studies also reported increased HCC risk in cirrhotic patients with alcohol as primary cause [87][88][89][90][91] . In a case-control study, heavy alcohol consumption contributed to a significant part of the 115 included HCC cases (32%), independent of other known risk factors [92] .…”

Section: Hcc Incidence In Cirrhotic Patientsmentioning

confidence: 90%

Surveillance for hepatocellular carcinoma in chronic liver disease: Evidence and controversies

Meer¹

2013

WJG

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Primary liver cancer is the sixth most common cancer in the world and the third cause of cancer-related death. Hepatocellular carcinoma (HCC) represents more than 90% of primary liver cancers and generally occurs in patients with underlying chronic liver disease such as viral hepatitis, hemochromatosis, primary biliary cirrhosis and non-alcoholic steatohepatitis. Especially cirrhotic patients are at risk of HCC and regular surveillance could enable early detection and therapy, with potentially improved outcome. We here summarize existing evidence for surveillance including ultrasound, other radiological modalities and various serum biomarkers, and current international guideline recommendations for surveillance. Ultrasound and α-fetoprotein (alone or in combination) are most frequently used for surveillance, but their sensitivities and specificities are still far from perfect, and evidence for surveillance remains weak and controversial. Various other potential surveillance tools have been tested, including serum markers as des-carboxyprothrombin, lectin-bound α-fetoprotein, and (most recently) circulating TIE2-expressing monocytes, and radiological investigations such as computed tomography-scan or magnetic resonance imaging-scan. Although early results appear promising, these tools have generally been tested in diagnostic rather than surveillance setting, and in most cases, no detailed information is available on their cost-effectiveness. For the near future, it remains important to define those patients with highest risk of HCC and most benefit from surveillance, and to restrict surveillance to these categories.

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Annual Incidence of Hepatocellular Carcinoma Among Patients With Alcoholic Cirrhosis and Identification of Risk Groups

Cited by 139 publications

References 27 publications

Prediction of future hepatocellular carcinoma incidence in moderate to heavy alcohol drinkers with the FIB‐4 liver fibrosis index

Prediction of future hepatocellular carcinoma incidence in moderate to heavy alcohol drinkers with the FIB‐4 liver fibrosis index

Surveillance for early diagnosis of hepatocellular carcinoma: How best to do it?

Surveillance for hepatocellular carcinoma in chronic liver disease: Evidence and controversies

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