Extrahepatic cancer risk among patients with liver cirrhosis in Taiwan: A nationwide population-based study.

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1564 Background: Cirrhosis is a well-known risk factor of hepatocellular carcinoma. However, the risk of extra-hepatic cancers (EHCs) is not clear in cirrhotic patients. This study is aimed to identify the risk and sites of EHCs among cirrhotic patients. Methods: Newly diagnosed cirrhotic patients between 2000 and 2011 were recruited from Taiwan's nationwide health insurance database. Patients aged < 20 years and those with antecedent malignancies were excluded. To avoid surveillance bias, EHCs that developed within one year were also excluded in further analysis. Standardized incidence ratios (SIRs) of EHCs in these patients were calculated by comparing to the EHC incidence in the general population. Univariate and multivariate Cox proportional hazards models were applied to find the predictors of EHCs development among patients with cirrhosis. Results: During the 12-year study period, 859 EHCs developed among 13,729 cirrhotic patients, with a median follow-up period of 4.44 years. The SIR for all patients was 2.17 (95% confidence interval [CI] 2.03-2.32), for cirrhosis due to alcohol 3.43 (95% CI 3.02-3.89), for hepatitis B 1.81 (95% CI 1.51-2.15) and for hepatitis C 1.83 (95% CI 1.52-2.19). The SIRs for cancers of esophagus (4.60), head and neck (2.43), skin (1.99), stomach (1.95), bladder (1.66), breasts (1.46), and lung and mediastinum (1.42) were significantly increased. Multivariate analysis showed that age ≥ 50 years (adjusted hazard ratio [HR] 2.26, 95% CI 1.85-2.75), being male (HR 1.57, 95% CI 1.29-1.90), and chronic obstructive pulmonary disease (HR 1.29, 95% CI 1.06-1.56) were independent factors. Conclusions: This largest cohort study demonstrated an increasing risk of EHCs among cirrhotic patients, especially cirrhosis due to alcohol. Risk factors for cancer development in patients with cirrhosis. Variables Multivariate analysis HR (95% CI) P Value Age ≥ 50 2.26 (1.85-2.75) < 0.001 Sex (male) 1.57 (1.29-1.90) < 0.001 Comorbidities Diabetes mellitus 1.15 (0.94-1.40) 0.165 COPD 1.29 (1.06-1.56) 0.011 Autoimmune diseases 0.86 (0.61-1.21) 0.382 Dyslipidemia 1.00 (0.82-1.22) 0.998 Chronic kidney disease 0.95 (0.74-1.21) 0.658 COPD: chronic obstructive pulmonary disease