Abstract
Hepatocellular carcinoma is one of the main important causes of cancer-related death and its mortality is increasingly worldwide. In Europe, alcohol abuse accounts for approximately half of all liver cancer cases and it will become the leading cause of hepatocellular carcinoma in the next future with the sharp decline of chronic viral hepatitis. The pathophysiology of alcohol-induced carcinogenesis involves acetaldehyde catabolism, oxidative stress and chronic liver inflammation. Genetic background plays also a significant role and specific patterns of gene mutations in alcohol-related hepatocellular carcinoma have been characterized. Survival is higher in patients who undergo specific surveillance programmes than in patients who do not. However, patients with alcohol cirrhosis present a significantly greater risk of liver decompensation than those with cirrhosis due to other aetiologies. Furthermore, the adherence to screening program can be suboptimal. Liver transplant for patients with Milan-in hepatocellular carcinoma represents the best possible treatment in case of tumour recurrence/progression despite loco-regional or surgical treatments. Long-term result after liver transplantation for alcohol related liver disease is good. However, cardiovascular disease and de novo malignancies can significantly hamper patients’ survival and should be carefully considered by transplant team. In this review, we have focused on the evolution of alcohol-related hepatocellular carcinoma epidemiology and risk factors as well as on liver transplantation in alcoholic patients with and without hepatocellular carcinoma.
Highlights
Hepatocellular carcinoma (HCC), arising in patients with liver cirrhosis, is the second most lethal cancer worldwide, with persistently increasing mortality in Europe, North/South America and Africa [1,2,3,4].Liver cirrhosis and HCC are the major life-limiting consequences of progressive fibrotic liver diseases, mainly caused by chronic viral infection, alcohol excessive consumption and non-alcoholic fatty liver disease [5].Despite chronic hepatitis B still represents the main cause of liver cancers worldwide [6], the burden of alcohol-related HCC is generally increasing [7]
In Europe, alcohol excessive consumption accounts for 40–50% of all liver cancer cases [8] and, with the sharp decline of chronic viral hepatitis, it has been estimated that alcohol will become the leading cause of liver cancer [7,9,10], at least in developed countries
Different studies confirmed that the long-term survival in patients who underwent liver transplantation for alcoholic liver disease is comparable with those of patients who were transplanted for other etiologies
Summary
Hepatocellular carcinoma (HCC), arising in patients with liver cirrhosis, is the second most lethal cancer worldwide, with persistently increasing mortality in Europe, North/South America and Africa [1,2,3,4]. In Europe, alcohol excessive consumption accounts for 40–50% of all liver cancer cases [8] and, with the sharp decline of chronic viral hepatitis, it has been estimated that alcohol will become the leading cause of liver cancer [7,9,10], at least in developed countries. With this regard, the “Global Burden of Disease Liver Cancer Collaboration. Cancers 2018, 10, 46 indication and management strategies, the general pre-transplant evaluation of alcoholic patients and long-term outcome of transplanted patients
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