Hepatocellular carcinoma in cirrhosis: Incidence and risk factors
Section snippets
The burden of HCC in cirrhosis
HCC is a common cause of death among patients with compensated cirrhosis. European cohort studies have reported that, among persons who died of a liver-related cause, HCC was the responsible cause in 54%6 to 70%7 of patients with compensated cirrhosis of different etiologies and in 50% of patients with HCV-related cirrhosis.8 Data from one of the longitudinal studies, which involved 112 cirrhotic patients with HCC detected during ultrasound surveillance, showed that tumor progression was the
HCC with and without underlying cirrhosis
Patients at risk for HCC include those with chronic HBV or HCV infection, certain metabolic liver disease, such as hereditary hemochromatosis and porphyria cutanea tarda, and those with cirrhosis, regardless of its etiology. The prevalence of cirrhosis in persons with HCC is about 80%–90% in autopsied series worldwide, and, therefore, approximately 10% to 20% of cases of HCC develop in persons without cirrhosis.1 Differences of geographic area, method of recruitment of the HCC cases (medical or
Incidence and risk factors for HCC according to etiology of cirrhosis
Although there have been several published studies on the risk of developing HCC in patients with cirrhosis, a comprehensive analysis is hampered by the different study designs (case control, cross-sectional, longitudinal), the heterogeneity of the patient populations relative to the severity of the cirrhosis stage at enrollment, and the lack of a focused analysis of HCC based on etiology. Furthermore, in studies involving subjects with HCV or HBV infection treated with interferon-α, separate
Age and gender
Older age and male sex have been found in longitudinal studies to be associated with an increased risk of HCC among persons with cirrhosis of different etiologies.6, 40, 133, 134 Older age may reflect a longer duration of cirrhosis. The higher risk of HCC among male cirrhotic patients could be explained by either the higher prevalence of other risk factors, such as alcohol abuse, or by a tumorigenic effect of androgens.
Stage of cirrhosis
In a surveillance program of a cohort of 313 Italian cirrhotic patients of
Summary
The following conclusions can be drawn: (1) Mortality from HCC is rising in some developed countries, whereas mortality from cirrhosis is either decreasing or is stable, possibly because of improved medical management of non-HCC complications of cirrhosis, leading to longer survival of cirrhotic patients. (2) Cohort studies indicate that HCC currently represents the major cause of liver-related death in patients with compensated cirrhosis. (3) Cirrhosis underlies HCC in approximately 80%–90% of
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