Abstract
The role of hepatocellular carcinoma (HCC) surveillance is being questioned in alcoholic cirrhosis because of the relative low HCC risk. This study aimed to assess the risk and predictors of HCC in Korean patients with alcoholic cirrhosis by using competing risk analysis. A total of 745 patients with alcoholic cirrhosis were recruited at a university-affiliated hospital in Korea and randomly assigned to either the derivation (n = 507) and validation (n = 238) cohort. Subdistribution hazards model of Fine and Gray was used with deaths and liver transplantation treated as competing risks. Death records were confirmed from Korean government databases. A nomogram was developed to calculate the Alcohol-associated Liver Cancer Estimation (ALICE) score. The cumulative incidence of HCC was 15.3 and 13.3% at 10 years for derivation and validation cohort, respectively. Age, alpha-fetoprotein level, and albumin level were identified as independent predictors of HCC and incorporated in the ALICE score, which discriminated low, intermediate, and high risk for HCC in alcoholic cirrhosis at the cut-off of 60 and 100. The risk of HCC can be stratified by using a combination of readily available clinical parameters (age, AFP level, and albumin level) in patients with alcoholic cirrhosis.
Highlights
Surveillance and delayed detection compared to viral hepatitis-associated H CC4
A recent Swedish cohort study (n = 3410) reported hepatocellular carcinoma (HCC) incidence rate of 6.2 per 1000 person-years and the 10-year cumulative incidence of only 5.0% in alcoholic c irrhosis[5], which was much lower than previously published[6–9]. Another recent Danish study showed similar result[10]. These findings suggest that HCC screening for all alcoholic cirrhosis may not be cost-effective, and that further risk stratification is warranted to identify ideal candidates for surveillance in alcoholic cirrhosis
745 patients with alcoholic cirrhosis were included in this study and randomly allocated to either derivation (n = 507) or validation cohort (n = 238)
Summary
Surveillance and delayed detection compared to viral hepatitis-associated H CC4. A recent Swedish cohort study (n = 3410) reported HCC incidence rate of 6.2 per 1000 person-years and the 10-year cumulative incidence of only 5.0% in alcoholic c irrhosis[5], which was much lower than previously published (annual incidence of 2.6–2.9%)[6–9] Another recent Danish study showed similar result (cumulative incidence of 6.0% after 10 years)[10]. We sought to perform a competing-risk analysis for predicting the risk and predictors of HCC in alcoholic cirrhosis patients in Korea. For this aim, we linked the Korean national death registry data to hospital-based cohort data
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