[HTML][HTML] Risk of cancer in biopsy-proven alcohol-related liver disease: a population-based cohort study of 3410 persons
H Hagström, M Thiele, R Sharma, TG Simon… - Clinical …, 2022 - Elsevier
Clinical Gastroenterology and Hepatology, 2022•Elsevier
Background & Aims Persons with alcohol-related liver disease (ALD) are at an increased
risk of death and liver-related endpoints, but the association with incident cancer is not well
understood, and whether it differs across histopathological subgroups is undefined. Methods
We investigated the risk of cancer in 3,410 persons with a diagnosis of ALD and an
available liver biopsy in Sweden between 1969-2016, compared to a matched reference
population. Administrative coding from national registers and liver biopsy data were used to …
risk of death and liver-related endpoints, but the association with incident cancer is not well
understood, and whether it differs across histopathological subgroups is undefined. Methods
We investigated the risk of cancer in 3,410 persons with a diagnosis of ALD and an
available liver biopsy in Sweden between 1969-2016, compared to a matched reference
population. Administrative coding from national registers and liver biopsy data were used to …
Background & Aims
Persons with alcohol-related liver disease (ALD) are at an increased risk of death and liver-related endpoints, but the association with incident cancer is not well understood, and whether it differs across histopathological subgroups is undefined.
Methods
We investigated the risk of cancer in 3,410 persons with a diagnosis of ALD and an available liver biopsy in Sweden between 1969-2016, compared to a matched reference population. Administrative coding from national registers and liver biopsy data were used to define exposure and outcome status. Competing risk regression, adjusted for available confounders and using non-cancer mortality as the competing risk, was used to estimate subdistribution hazard ratios (sHRs) for incident cancer.
Results
At baseline, persons with ALD had a median age of 58.2 years, 67% were men, and 2,042 (60%) had cirrhosis. ALD was not associated with cancer in general (sHR = 1.01, 95%CI = 0.92-1.11), although the risk was increased in persons surviving ≥1 year (sHR = 1.19, 95% CI = 1.08-1.32). The risk of liver cancer was elevated sHR = 12.80, 95%CI = 9.38-17.45). HCC incidence among ALD persons with cirrhosis was 8.6 cases/1,000 person-years, corresponding to a cumulative incidence after 10 years of 5.0%.
Conclusions
Persons with biopsy-proven ALD that survive the initial time after diagnosis are at an elevated risk for cancer, in particular HCC compared with the general population. Although the risk for HCC was elevated, data do not suggest that routine surveillance for HCC in ALD cirrhosis is cost-effective.
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