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Meta-Analysis
. 2023 May;21(5):1169-1177.
doi: 10.1016/j.cgh.2022.06.032. Epub 2022 Aug 5.

Hepatocellular Carcinoma Incidence in Alcohol-Associated Cirrhosis: Systematic Review and Meta-analysis

Daniel Q Huang  1 , Darren J H Tan  2 , Cheng Han Ng  2 , Maral Amangurbanova  3 , Nancy Sutter  3 , Phoebe Wen Lin Tay  2 , Wen Hui Lim  2 , Jie Ning Yong  2 , Ansel Tang  2 , Nicholas Syn  2 , Mark D Muthiah  4 , Eunice X X Tan  4 , Shravan Dave  3 , Benjamin Tay  5 , Abdul M Majzoub  6 , Danielle Gerberi  7 , Beom Kyung Kim  8 , Rohit Loomba  9
Affiliations
Meta-Analysis

Hepatocellular Carcinoma Incidence in Alcohol-Associated Cirrhosis: Systematic Review and Meta-analysis

Daniel Q Huang et al. Clin Gastroenterol Hepatol. 2023 May.

Abstract

Background & aims: Alcohol is one of the leading causes of hepatocellular carcinoma (HCC). However, pooled estimates of HCC incidence in alcohol-associated cirrhosis have not been evaluated systematically. We performed a pooled analysis of time-to-event data to provide robust estimates for the incidence of HCC in alcohol-associated cirrhosis.

Methods: Medline, Embase, Cochrane Central Register, Scopus, and Web of Science were searched from inception to August 2021. Individual patient data were reconstructed from published Kaplan-Meier curves, and a pooled analysis of cumulative HCC incidence was performed using a random-effects model.

Results: We screened 5022 articles and included 18 studies (148,333 patients). In the pooled analysis, the cumulative incidence of HCC in alcohol-associated cirrhosis at 1, 5, and 10 years among studies that accounted for the competing risk of death without HCC was 1%, 3%, and 9%, respectively. A secondary analysis by traditional meta-analysis determined that the HCC incidence rate was higher in cohorts enrolled in a HCC surveillance program (18.6 vs 4.8 per 1000 person-years; P = .001) vs those who were not enrolled in a surveillance program. Meta-regression showed that diabetes, smoking, variceal bleeding, and hepatic decompensation were associated with a higher risk of HCC.

Conclusions: Our analysis determined that the 5- and 10- year cumulative risk of HCC in alcohol-associated cirrhosis was 3% and 9%, respectively, with a higher incidence in cohorts that were enrolled in a HCC surveillance program. These data should be validated further in large prospective studies, and may have important implications for HCC screening and surveillance among patients with alcohol-associated cirrhosis.

Keywords: Alcohol; Cirrhosis; Hepatocellular Carcinoma; Incidence.

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Conflict of interest statement

These authors disclose the following: Daniel Q. Huang has received funding support from the Singapore Ministry of Health’s National Medical Research Council under its National Medical Research Council (NMRC) Research Training Fellowship (MOH-000595-01).

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of included articles. HCC, hepatocellular carcinoma.
Figure 2.
Figure 2.
Cumulative risk of hepatocellular carcinoma (HCC) among patients with alcohol-associated cirrhosis among studies that accounted for competing risk of death without HCC, by reconstructed individual patient data meta-analysis.
See this image and copyright information in PMC

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