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. 2023 Mar 9;15(6):1687.
doi: 10.3390/cancers15061687.

Causes of Death among Patients with Hepatocellular Carcinoma According to Chronic Liver Disease Etiology

Yi-Hao Yen  1 , Kwong-Ming Kee  1 , Wei-Feng Li  2 , Yueh-Wei Liu  2 , Chih-Chi Wang  2 , Tsung-Hui Hu  1 , Ming-Chao Tsai  1 , Yuan-Hung Kuo  1 , Chih-Yun Lin  3
Affiliations

Causes of Death among Patients with Hepatocellular Carcinoma According to Chronic Liver Disease Etiology

Yi-Hao Yen et al. Cancers (Basel). .

Abstract

This study was conducted to determine whether the causes of death among patients with hepatocellular carcinoma (HCC) differ according to chronic liver disease (CLD) etiology. Between 2011 and 2020, 3977 patients who were newly diagnosed with HCC at our institution were enrolled in this study. We determined whether the cause of death was HCC-related and non-HCC-related. For patients with multiple CLD etiologies, etiology was classified using the following hierarchy: hepatitis C virus (HCV) > hepatitis B virus (HBV) > alcohol-related causes > all negative. All negative was defined as negative for HCV, HBV, and alcohol-related causes. Among 3977 patients, 1415 patients were classified as HCV-related, 1691 patients were HBV-related, 145 patients were alcohol-related, and 725 patients were all negative. HCC-related mortality was the leading cause of death, irrespective of etiology. Among patients who underwent curative treatment, HCC-related mortality was the leading cause of death for patients in the HCV, HBV, and all-negative groups, but not for patients in the alcohol-related group. Among patients 75 years and older who underwent curative treatment, HCC-related mortality was the leading cause of death in the HCV but not HBV or all-negative groups. In conclusion, although most patients with HCC die due to HCC-related causes, non-HCC-related mortality represents a competing event in certain patient subgroups. The current study results underscore the importance of assessing and managing underlying comorbidities, particularly among patients with HCC at risk of non-HCC-related mortality.

Keywords: cause-specific mortality; chronic liver disease (CLD); liver cancer.

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Conflict of interest statement

The authors have no conflict of interest to disclose for all authors.

Figures

Figure 1
Figure 1
Cumulative mortality risk for hepatocellular carcinoma according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; (C) alcohol use; and (D) all negative (defined as no evidence of virus infection or alcohol use).
Figure 1
Figure 1
Cumulative mortality risk for hepatocellular carcinoma according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; (C) alcohol use; and (D) all negative (defined as no evidence of virus infection or alcohol use).
Figure 2
Figure 2
Cumulative mortality risk for hepatocellular carcinoma among patients who received curative treatments according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; (C) alcohol use; and (D) all negative (defined as no evidence of virus infection or alcohol use).
Figure 2
Figure 2
Cumulative mortality risk for hepatocellular carcinoma among patients who received curative treatments according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; (C) alcohol use; and (D) all negative (defined as no evidence of virus infection or alcohol use).
Figure 2
Figure 2
Cumulative mortality risk for hepatocellular carcinoma among patients who received curative treatments according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; (C) alcohol use; and (D) all negative (defined as no evidence of virus infection or alcohol use).
Figure 3
Figure 3
Cumulative mortality risk for hepatocellular carcinoma among patients younger than 75 years who received curative treatments according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; (C) alcohol use; and (D) all negative (defined as no evidence of virus infection or alcohol use).
Figure 3
Figure 3
Cumulative mortality risk for hepatocellular carcinoma among patients younger than 75 years who received curative treatments according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; (C) alcohol use; and (D) all negative (defined as no evidence of virus infection or alcohol use).
Figure 4
Figure 4
Cumulative mortality risk for hepatocellular carcinoma among patients 75 years and older who received curative treatments according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; and (C) all negative (defined as no evidence of virus infection or alcohol use).
Figure 4
Figure 4
Cumulative mortality risk for hepatocellular carcinoma among patients 75 years and older who received curative treatments according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; and (C) all negative (defined as no evidence of virus infection or alcohol use).
Figure 5
Figure 5
Cumulative mortality risk for hepatocellular carcinoma among patients who received non-curative treatments according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; (C) alcohol use; and (D) all negative (defined as no evidence of virus infection or alcohol use).
Figure 5
Figure 5
Cumulative mortality risk for hepatocellular carcinoma among patients who received non-curative treatments according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; (C) alcohol use; and (D) all negative (defined as no evidence of virus infection or alcohol use).
Figure 5
Figure 5
Cumulative mortality risk for hepatocellular carcinoma among patients who received non-curative treatments according to chronic liver disease etiology: (A) hepatitis C virus; (B) hepatitis B virus; (C) alcohol use; and (D) all negative (defined as no evidence of virus infection or alcohol use).
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