Saturday, January 1, 2011

Hepatitis C and B : Cirrhosis etiology a major factor in cancer risk

Last Updated: 2010-12-30 18:55:16 -0400 (Reuters Health)

By Scott Baltic

NEW YORK (Reuters Health) - Patients with cirrhosis are at a significantly higher risk of cancer - not just hepatocellular carcinoma (HCC) but extrahepatic cancers (EHC) too - and a new study by U.S. researchers adds to what's already known about those risks.

One of the study's most striking findings was that cirrhosis etiology was a major factor in cancer risk.

Patients with hepatitis B or C cirrhosis (with or without alcohol use) had a five-year risk of HCC of 11.2%. Those with primary biliary cirrhosis, primary sclerosis cholangitis, alpha-one antitrypsin deficiency-related cirrhosis or alcohol-related liver disease, however, had only a 3.4% five-year probability of HCC.

In contrast, the risk of EHC was highest in patients with primary biliary cirrhosis or alcoholic cirrhosis.

For analysis of EHC risk, the researchers followed 952 patients with cirrhosis; for HCC risk, they followed 797 (after excluding patients who were positive for HCC on index CT screening or who were found to have HCC within six months of enrollment).

Overall, the cirrhotic patients had a risk of HCC that was 186 times higher than in the general population. Point estimates of HCC incidence at one, three and five years after a first negative CT scan were 1.2%, 4.4% and 7.8%, respectively, according to lead author Dr. Ken Berman of the University of Colorado School of Medicine, Denver and colleagues.

The cohort's risk of EHC was nearly double that of the general population. Point estimates of EHC incidence at one, three and five years were 2.2%, 4.5% and 6.8%, respectively. The most common EHCs were breast cancer, lung cancer and lymphoma, the research team reported online December 21st in the American Journal of Gastroenterology.

The results do not support "enhanced screening for any particular EHC in an otherwise asymptomatic patient with cirrhosis," Dr. Berman told Reuters Health by e-mail. But, he added, they do suggest a need for "heightened awareness for early warning signs of cancer in these patients."

The researchers say theirs is the first study to evaluate EHC risk in a cohort of patients with cirrhosis of all etiologies in the United States.

Both male patients and older patients were significantly more likely to be diagnosed with HCC during follow-up.


Am J Gastroenterol 2010.

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