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Risk of hepatocellular carcinoma among individuals with different aetiologies of cirrhosis: a population‐based cohort study
Author(s) -
West J.,
Card T. R.,
Aithal G. P.,
Fleming K. M.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13961
Subject(s) - medicine , cirrhosis , hepatocellular carcinoma , cumulative incidence , population , incidence (geometry) , proportional hazards model , viral hepatitis , etiology , hazard ratio , alcoholic liver disease , gastroenterology , cohort , confidence interval , environmental health , physics , optics
Summary Background Among patients with cirrhosis, only those determined to be at risk for hepatocellular carcinoma (HCC) should undergo surveillance. However, little is known about how different aetiologies of cirrhosis affect risk for HCC. Aim To quantify the cumulative incidence of HCC among a representative population of people with cirrhosis of the liver of varying aetiology. Methods We identified subjects with hepatic cirrhosis from the UK's General Practice Research Database (1987–2006). Diagnoses of HCC were obtained from linked national cancer registries (1971–2006). Cox proportional hazards regression was used to estimate hazard ratios. The predicted 10‐year cumulative incidence of HCC for each aetiology of cirrhosis was estimated while accounting for competing risks of death from any cause and liver transplant. Results Among 3107 people with cirrhosis, the adjusted relative risk of HCC was increased twofold to threefold among people with viral and autoimmune/metabolic aetiologies, compared to those with alcohol‐associated cirrhosis. The 10‐year predicted cumulative incidence estimates of HCC for each aetiology were alcohol, 1.2%; chronic viral hepatitis, 4.0%; autoimmune or metabolic disease, 3.2%; and cryptogenic, 1.1%. Conclusions In a population‐based study in the UK, people with cirrhosis have an estimated cumulative 10‐year incidence of HCC of 4% or lower. Cumulative incidence varies with aetiology such that individuals with alcohol or cryptogenic cirrhosis have the lowest risk for HCC. These findings provide important information for cost‐effectiveness analyses of HCC surveillance.