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Research Summary

    Do Patients with Alcoholic Cirrhosis Require Surveillance for Hepatocellular Carcinoma?

Although surveillance for hepatocellular carcinoma (HCC) in patients with alcoholic cirrhosis is recommended by some guidelines, the benefit of this practice is uncertain. To address this, researchers used a nationwide Danish registry to identify individuals with an index diagnosis of alcoholic cirrhosis between 1995 and 2005. They measured incidence of HCC and mortality from 1 year after the diagnosis until the end of 2009.

  • A total of 8482 patients were diagnosed with alcohol cirrhosis, 169 of whom (2%) developed HCC, for a 5-year HCC risk of 1%.
  • Hepatocellular carcinoma incidence was much higher in men (5.8 per 1000 person-years) than in women (0.7 per 1000 person-years).
  • Five-year cumulative all-cause mortality was 44%, and the 5-year risk for death from HCC was 0.8% (i.e., 1.8% of deaths were due to HCC).
  • Sensitivity analyses indicated an upper bound 5-year HCC risk of 1.9%, but this had no appreciable impact on cumulative mortality.

Comments:

Results of this large registry-based cohort study indicate that, although patients with alcoholic cirrhosis do have increased risk for HCC and high overall mortality, their risk of dying from HCC is very low. This finding suggests that regular surveillance for HCC should not be done in patients with alcoholic cirrhosis. Since this was a single-nation analysis, it would be helpful for the study to be replicated in other countries. Kevin L. Kraemer, MD, MSc

Reference:

Jepsen P, Ott P, Andersen PK, et al. Risk for hepatocellular carcinoma in patients with alcoholic cirrhosis: a Danish nationwide cohort study. Ann Intern Med. 2012;156(12): 841–847.

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