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Abstract Details
Hepatocellular Carcinoma Incidence in Alcohol-Associated Cirrhosis: Systematic Review and Meta-analysis
Clin Gastroenterol Hepatol. 2022 Aug 5;S1542-3565(22)00727-3.doi: 10.1016/j.cgh.2022.06.032. Online ahead of print.
1Nonalcoholic Fatty Liver Disease Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore.
2Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
3Nonalcoholic Fatty Liver Disease Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California.
4Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore.
5Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore.
6Division of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania.
7Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota.
8Nonalcoholic Fatty Liver Disease Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
9Nonalcoholic Fatty Liver Disease Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, California. Electronic address: roloomba@ucsd.edu.
Abstract
Background & aims: Alcohol is one of the leading causes of hepatocellular carcinoma (HCC). However, pooled estimates of HCC incidence in alcohol-associated cirrhosis have not been evaluated systematically. We performed a pooled analysis of time-to-event data to provide robust estimates for the incidence of HCC in alcohol-associated cirrhosis.
Methods: Medline, Embase, Cochrane Central Register, Scopus, and Web of Science were searched from inception to August 2021. Individual patient data were reconstructed from published Kaplan-Meier curves, and a pooled analysis of cumulative HCC incidence was performed using a random-effects model.
Results: We screened 5022 articles and included 18 studies (148,333 patients). In the pooled analysis, the cumulative incidence of HCC in alcohol-associated cirrhosis at 1, 5, and 10 years among studies that accounted for the competing risk of death without HCC was 1%, 3%, and 9%, respectively. A secondary analysis by traditional meta-analysis determined that the HCC incidence rate was higher in cohorts enrolled in a HCC surveillance program (18.6 vs 4.8 per 1000 person-years; P = .001) vs those who were not enrolled in a surveillance program. Meta-regression showed that diabetes, smoking, variceal bleeding, and hepatic decompensation were associated with a higher risk of HCC.
Conclusions: Our analysis determined that the 5- and 10- year cumulative risk of HCC in alcohol-associated cirrhosis was 3% and 9%, respectively, with a higher incidence in cohorts that were enrolled in a HCC surveillance program. These data should be validated further in large prospective studies, and may have important implications for HCC screening and surveillance among patients with alcohol-associated cirrhosis.