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. 2019 Nov;8(15):6624-6633.
doi: 10.1002/cam4.2543. Epub 2019 Sep 18.

The clinical behavior and survival of patients with hepatocellular carcinoma and a family history of the disease

Jihyun An  1 , Seheon Chang  2 , Ha Il Kim  3 , Gi-Won Song  4   5 , Ju Hyun Shim  3   5
Affiliations

The clinical behavior and survival of patients with hepatocellular carcinoma and a family history of the disease

Jihyun An et al. Cancer Med. 2019 Nov.

Abstract

Purpose: Familial clustering is a common feature of hepatocellular carcinoma (HCC) as well as a risk factor for the disease. We aimed to assess whether such a family history affected prognostic outcomes in patients with HCC diagnosed at different stages of the disease.

Materials/methods: This hospital registry-based cohort study included 5484 patients initially diagnosed with HCC. Individual family histories of cancer were obtained by interview and reported by trained nurses who constructed three-generation pedigrees. Overall survival data were compared between cases with and without first-degree relatives affected by HCC, with adjustment for other potential predictors.

Results: Of 5484 patients, 845 (15.4%) had first-degree relatives with a history of HCC. Family history was associated with longer survival in the entire cohort (adjusted hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80-0.98, P = .025). A significant trend for reduced risk of death with increasing number of affected family members was also observed (P for trend = 0.018). The stage-stratified analysis showed that the presence of family history was especially associated with a reduced risk of death in the subset of patients with HCC at a (very) early stage (adjusted HR 0.83, 95% CI 0.69-0.99; P = .042). The proportion of cases receiving curative treatment was also higher in early-stage patients with a family history (72.6% vs 63.3%; P < .001).

Conclusions: A first-degree family history of the disease is a prognostic factor for improved survival in patients with HCC, especially in those whose tumors can be cured by radical treatments.

Keywords: clustering; family; liver cancer; prognosis; treatment.

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Figures

Figure 1
Figure 1
Patient flow diagram
Figure 2
Figure 2
A, Association between presence of family history and overall survival. A first degree family history was significantly associated with longer survival of HCC patients, (B) Overall survival according to number of family members with a history of HCC. There was a significant trend for improved survival with increasing number of affected family members
Figure 3
Figure 3
Presence of a family history of HCC and overall survival stratified into BCLC stage ([A] BCLC stage 0 or A, [B] BCLC stage B, [C] BCLC stage C, and [D] BCLC stage D). A family history was associated with better outcomes in patients with BCLC 0‐A stage HCC, but not in those with BCLC stages B‐D
Figure 4
Figure 4
Anti‐HCC treatments according to presence of a family history of HCC in patients with BCLC 0‐A stage HCC. The proportion of patients undergoing curative resection was significantly higher in the group with familial clustering of HCC, whereas treatment with TACE was more prevalent in the sporadic HCC cases
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