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Comparative Study
. 2018 Sep 27;13(9):e0204412.
doi: 10.1371/journal.pone.0204412. eCollection 2018.

Differences in hepatocellular carcinoma risk, predictors and trends over time according to etiology of cirrhosis

George N Ioannou  1   2   3 , Pamela Green  3 , Elliott Lowy  3 , Elijah J Mun  4 , Kristin Berry  3
Affiliations
Comparative Study

Differences in hepatocellular carcinoma risk, predictors and trends over time according to etiology of cirrhosis

George N Ioannou et al. PLoS One. .

Abstract

Background and aims: Hepatocellular carcinoma (HCC) risk is high in cirrhosis. We sought to describe differences in HCC risk, predictors and trends over time according to etiology of cirrhosis.

Methods: We identified 116,404 patients with cirrhosis diagnosed between 2001-2014 in the VA healthcare system and determined incident HCC cases occurring from the date of cirrhosis diagnosis until 01/31/2017. Patients were divided by cirrhosis etiology into hepatitis C virus (HCV, n = 52,671), alcoholic liver disease (ALD, n = 35,730), nonalcoholic fatty liver disease (NAFLD, n = 17,354), or OTHER (n = 10,649).

Results: During a mean follow-up of 4.3 years, 10,042 new HCC cases were diagnosed. Patients with HCV had >3 times higher incidence of HCC (3.3 per 100 patient-years) than patients with ALD (0.86/100 patient-years), NAFLD (0.90/100 patient-years) or OTHER (1.0/100 patient-years), an association that persisted after adjusting for baseline characteristics. HCC incidence was 1.6 times higher in patients with cirrhosis diagnosed in 2008-2014 (2.47/100 patient-years) than in 2001-2007 (1.55/100 patient-years). Independent predictors of HCC among all cirrhosis etiologies included: age, male sex, Hispanic ethnicity, high serum alpha fetoprotein, alkaline phosphatase and AST/√ALT ratio and low serum albumin and platelet count. Diabetes was associated with HCC in ALD-cirrhosis and NAFLD-cirrhosis, and BMI in ALD-cirrhosis.

Conclusions: HCC risk is 3 times greater in cirrhotic patients with HCV than ALD or NAFLD. HCC risk continues to increase over time in analyses extending to 2017 in cirrhosis of all etiologies. Multiple readily available risk factors for HCC were identified that were influenced by cirrhosis etiology and could be used to develop HCC risk estimation models.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Kaplan-Meier curves showing the probability of being free of HCC after the diagnosis of cirrhosis, plotted by a.
Etiology of cirrhosis. b. Age. c. Serum AFP level. d. Blood platelet count. e. Serum AST/√ALT ratio. f. Serum albumin level.
Fig 2
Fig 2. Kaplan-Meier curves showing the probability of being free of HCC after the diagnosis of cirrhosis, comparing patients diagnosed with cirrhosis in 2001–2007 to those diagnosed in 2008–2014.
a. All patients. b. HCV. c. ALD. d. NAFLD.
See this image and copyright information in PMC

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