Incidence of and risk factors for hepatocellular carcinoma in primary biliary cirrhosis: National data from Japan

Abstract

Primary biliary cirrhosis (PBC) primarily affects females and is rarely complicated by hepatocellular carcinoma (HCC). Although the HCC incidence in PBC patients is low, several characteristics and risk factors associated with its development have been reported. In this study, national data concerning the current status of carcinogenesis in PBC patients in Japan are reviewed. Using data from two national questionnaire surveys, we investigated the clinicopathological findings associated with HCC in PBC patients. According to the data of all reviewed PBC patients, the HCC incidence was 2.4% (71/2946). The HCC incidence by gender was 5.1% (19/370) in males and 2.0% (52/2576) in females, and the proportion of males was 26.7%. Prognosis was significantly poorer in the PBC patients with HCC than in those without. Multivariate analysis of risk factors associated with HCC by gender revealed histological stage at the time of PBC diagnosis as an independent risk factor associated with the development of HCC in females, but not in males. Furthermore, data from another national survey of 178 PBC patients with HCC (male/female 5 49/129; proportion of males 27.5%) revealed that the duration between the diagnosis of PBC and that of HCC was significantly shorter in males than in females. In addition, histological stage at the time of HCC diagnosis was an independent risk factor for HCC in females, whereas no risk factors were identified in males. Conclusion: these data indicate that males are at risk of developing HCC at any histological stage of PBC. Therefore, male PBC patients in particular should be carefully screened for HCC from the early stages of PBC. (HEPATOLOGY 2013;57:1942-1949

Risk Factors for Survival and the Development of Hepatocellular Carcinoma in Patients with Primary Biliary Cirrhosis

“…We also found that HCC development is a significant risk factor for survival in patients with PBC. Because the PBC patients had already progressed to an advanced histological stage at the time of HCC diagnosis, these results appear to be reasonable and are consistent with those of a study from Spain and Italy (9) and a recent Japanese report based on a nationwide survey (10). In fact, the six PBC patients with HCC (6/9, 67%) evaluated in the present study died of hepatic failure (Table 2).…”

“…Additionally, whether the development of HCC affects the overall survival of patients with PBC remains controversial (5,7,9,10). This matter and the identification of risk factors for HCC development are of importance for improving the prognosis of patients with PBC.…”

Geoepidemiology and changing mortality in primary biliary cholangitis

“…HCC occurred in less than 5% of patients, but the risk was significantly increased by increased age, male sex, diabetes mellitus, and previous hepatitis B virus infection [46]. In another large cohort in Japan, the HCC incidence was 2.4% (71/2946), and male sex and advanced histological stage in females are independent risk factors for the development of HCC in patients with PBC [45].…”

“…A recent study conducted by [44]. The role of male sex in the development of HCC in PBC has also been found in a representative cohort of Chinese and Japanese patients with a long follow-up [45,46]. A large cohort of 1865 well-defined Chinese patients with PBC were evaluated for the incidence of HCC up to 20 years.…”

Increased glyceraldehyde-3-phosphate dehydrogenase expression indicates higher survival rates in male patients with hepatitis B virus-accociated hepatocellular carcinoma and cirrhosis

“…Over 50% of the annual HCC cases reported worldwide are diagnosed in the Chinese population (3), while hepatitis B virus (HBV) infection is responsible for 80% of all HCC causes in China (4). While a number of studies have revealed that HBV infection is the key pathogenic factor for the development of HCC, male gender and cirrhosis have also been found to be independent risk factors for the occurrence of HCC (5)(6)(7). However, few studies exist on patients presenting all these risk factors.…”