Distinctive Features and Outcomes of Hepatocellular Carcinoma in Patients With Alcohol-Related Liver Disease: A US Multicenter Study

Abstract

Introduction: The burden of hepatocellular carcinoma (HCC) occurring in patients with alcoholic liver disease (ALD) is increasing at an alarming rate. The aims of this study were to compare the patient and tumor characteristics of HCC occurring in ALD-alone relative to and in addition to other chronic liver diseases. Methods: Patients diagnosed with HCC between 2000 and 2014 were identified at 5 US clinical centers. The patients were categorized as ALD-alone, ALD plus viral hepatitis, or a non-ALD etiology. Clinical and tumor characteristics among the 3 groups were compared, and survival probability was estimated by the Kaplan-Meier method. The frequency of noncirrhotic HCC was compared across the 3 groups. Results: A total of 5,327 patients with HCC were analyzed. Six hundred seventy (12.6%) developed HCC due to underlying ALD. Ninety-one percent of ALD-related HCC arose in men, in contrast to non-ALD etiologies where men accounted for 70% of HCCs cases (P < 0.001). Patients with ALD-alone-related HCC were older at diagnosis and had tumors less likely to be detected as part of routine surveillance. The ALD-alone cohort was least likely to be within the Milan criteria and to undergo liver transplantation. Overall survival in the ALD-alone HCC cohort was lower than the other 2 groups (1.07 vs 1.31 vs 1.41 years, P < 0.001). HCC in the noncirrhotic ALD cohorts occurred in only 3.5% of the patients compared with 15.7% in patients with non-ALD etiologies (P < 0.001). DISCUSSION: HCC occurring in patients with ALD occurred mostly in older men and almost exclusively in a cirrhotic background. They present with advanced tumors, and their survival is lower than HCCs occurring in non-ALD.

On‐treatment gamma‐glutamyl transferase predicts the development of hepatocellular carcinoma in chronic hepatitis B patients

“…In conclusion, on‐treatment serum GGT levels at 6 months of NUCs treatment strongly predicted HCC development among CHB patients, particularly non‐cirrhotic patients treated with NAs in Asia. As MAFLD and alcoholic liver disease are less prevalent in Asia, 40,41 these findings may guide further studies incorporating surrogate markers into HCC prediction models for other populations with different ethnicities.…”

Alcoholic Liver Disease-Related Hepatocellular Carcinoma: Characteristics and Comparison to General Slovak Hepatocellular Cancer Population

“…Similar results have been reported from the ITA.LI.CA database by Bucci et al, where as much as 30.4% of ALD-HCC patients received palliative treatment irrespective of their BCLC stage, compared to only 19.8% of patients with HCV-HCC. Furthermore, in the French cohort, authors reported that significantly fewer patients with ALD-HCC received potentially curative treatment compared to the control group (16.3% vs. 27.1%) [ 20 ], and this was confirmed in yet another study by deLemos et al [ 21 ]. The aforementioned authors commonly cite reasons such as delayed diagnosis due to lower rates of HCC screening due to poorer access to healthcare, decreased compliance or even prejudice against alcohol consumers; however, the data exploring the causes are lacking.…”

“…This was probably due to extreme variability of AFP levels in both ALD-HCC and control HCC groups. The previously referenced study by deLemos indeed found that AFP levels were lower in ALD-HCC despite identical maximal tumor size [ 21 ]. Poorer liver function is also commonly associated with ALD-HCC in the literature.…”

“…Indeed, as is shown in Table 2 , patients with ALD-related HCC had on average marginally smaller maximal tumor size, which was borderline insignificant, and on the other hand these patients had poorer liver function as shown by worse Child–Pugh and MELD scores. A similar study by deLemos et al from five clinical centers in the US on a much larger sample size ( n = 5327) did not find a difference in the maximal tumor size; however, patients with ALD-HCC were less frequently diagnosed within the Milan criteria, at least numerically, although the difference approached significance [ 21 ]. Despite expectations, patients did not differ significantly in AFP levels, although numerical difference in medians was quite substantial.…”

Cutoff values of protein induced by vitamin K absence or antagonist II for diagnosing hepatocellular carcinoma

“…Data on alcohol consumption and diagnosis of MAFLD were not available, but alcoholic liver disease and MAFLD were less prevalent in Asia. [ 31 , 32 ] Half of the patients with HCC were with more than TNM stage II in the study, which might elevate the PIVKA-II cutoff values. However, we analyzed the subgroup, and the optimal cutoff value to predict early-stage HCC was also 78.0 mAU/mL.…”