Incidence and risk factors for hepatocellular cancer in individuals with haemophilia: A National Inpatient Sample Study.

Abstract

Among haemophilic (H) men, hepatitis C virus (HCV) is the leading cause of liver disease and mortality, but demographics and risks of hepatocellular carcinoma (HCC) in H are not well known. Adult discharges in H and non-haemophilic (NH) men, with and without HCC were identified in the National Inpatient Sample (NIS) between 1998 and 2014, using ICD-9 codes. Analyses included NIS-provided discharge-level weights to reflect national estimates. Categorical variables were assessed by Rao-Scott chi-square and continuous variables by weighted simple linear regression. HCC predictors were determined by weighted multivariable logistic regression. Of 18098 H, 144 (0.79%) had HCC between 1998 and 2014. Adjusted rates of HCC increased 3.0-fold in H vs 1.7-fold in NH (P=0.484). Among HCV+, HCC rates adjusted for HIV, increased 2.2-fold in H vs 1.7-fold in NH (P=0.740), while among HIV+, HCC increased 1.4-fold in H vs 0.2-fold in NH (P=0.448). Among those with HCC, H were older than NH (P<0.001), Caucasian (P=0.006), platelet transfusion recipients (P<0.001), with greater comorbidity (P<0.001) and mortality (P<0.006). H with HCC also had greater rates of HCV and HIV (each P<0.001), lower rates of alcoholism and hyperlipidemia (each P<0.001), and similar rates of HBV (P=0.866), smoking (P=0.507) and obesity (P=0.502). In multivariable logistic regression, HCV was a strong predictor for HCC in haemophilia, (OR: 15.42, 95% CI: 8.75-27.16). Haemophilic men have increasing rates of HCC, similar to men without haemophilia. HCV is the major predictor of HCC in haemophilia. Future trends in HCC will depend on the impact of newer HCV antiviral therapy.