Delayed Diagnosis of HCC with Chronic Alcoholic Liver Disease

Abstract

Background: Adherence to surveillance recommendations for patients at risk of developing hepatocellular carcinoma (HCC) is influenced by several factors, including the etiology of chronic liver disease. Aim: The aim of this study was to analyze whether tumor stage at diagnosis and prognosis differ in patients with alcohol-related HCC compared to those with chronic viral hepatitis-related HCC. Patients and Methods: Medical records of 650 patients diagnosed with HCC between 1994 and 2011 were analyzed retrospectively. Groups were formed from patients having either alcohol abuse or viral hepatitis (chronic hepatitis B or C virus infection) as the only known HCC risk factors. Demographic data (age and gender), tumor stage at diagnosis, survival, liver function [Child-Pugh-Turcotte (CPT) score] in patients with liver cirrhosis, complications of liver cirrhosis, and serologic parameters were compared between the two groups. Results: A total of 393 HCC cases (male 84%, median age 65 years) were identified, with alcohol abuse as the causative factor in 76.8% and chronic viral hepatitis in 23.2%. In patients with alcohol abuse, 278 (92.1%) were diagnosed with liver cirrhosis (CPT A 49.3%, CPT B 31.1%, CPT C 9.6%), while in patients with viral hepatitis, 84 (92. of underlying chronic liver disease and is more progressed in patients having a disease with alcoholic etiology. Majority of HCC patients are not diagnosed at a curable stage, which underlines the need for specialized care for all patients with chronic liver disease, independent of etiology and consequent adherence to current surveillance guidelines.

Cancer incidence among alcoholic liver disease patients in Finland: A retrospective registry study during years 1996–2013

“…Nonetheless, there was a significantly increased incidence of liver cancer during the whole follow‐up time. Although ALD patients have a lower risk for HCC than cirrhotic patients with chronic viral hepatitis, liver cancers tend to be more advanced at the time of diagnosis in ALD patients . Thus, the results of the present study emphasise the importance of regular ultrasound surveillance recommended by guidelines .…”

Hepatocellular carcinoma is diagnosed at a later stage in alcoholic patients: Results of a prospective, nationwide study

“…10,11 Various assumptions can be made to explain why patients with alcohol-related HCC have reduced survival in comparison with patients with non-alcohol-related HCC: a diagnosis at a later stage due to lower rates of HCC screening, worse liver function and/or ongoing alcohol consumption preventing curative options, and discrimination against alcoholic patients leading to less aggressive treatment options. 10,11 Various assumptions can be made to explain why patients with alcohol-related HCC have reduced survival in comparison with patients with non-alcohol-related HCC: a diagnosis at a later stage due to lower rates of HCC screening, worse liver function and/or ongoing alcohol consumption preventing curative options, and discrimination against alcoholic patients leading to less aggressive treatment options.…”

“…7 The annual incidence of HCC in patients with alcoholic liver cirrhosis is 1% to 2%. 10,11 The CHANGH cohort (cohorte de Carcinomes Hepatocelulaires de l'Association des h epato-Gastroent erologues des Hôpitaux G en eraux) was a French prospective, observational cohort study that collected data on the clinical features and treatment allocations of patients with newly diagnosed HCC. 8,9 Recent retrospective studies suggest that the tumor stage at diagnosis is influenced by the etiology, with alcoholrelated HCC being diagnosed at a later stage.…”

Proangiogenic factors in the development of HCC in alcoholic cirrhosis

“…All rights reserved. abuse and HCC were diagnosed with liver cirrhosis [6]. These data suggest that advanced fibrosis with cirrhosis is already present, when HCC develops in heavy alcohol consumers, in the majority of cases.…”