Light-to-moderate alcohol intake increases risk of HCC in patients with HCV-related cirrhosis

Alcohol intake increases the risk of HCC in hepatitis C virus-related compensated cirrhosis: A prospective study

Hélène Vandenbulcke, Christophe Moreno, Isabelle Colle, Jean-François Knebel, Sven Francque, Thomas Sersté, Christophe George, Chantal de Galocsy, Wim Laleman, Jean Delwaide, Hans Orlent, Luc Lasser, Eric Trépo, Hans Van Vlierberghe, Peter Michielsen, Marc van Gossum, Marie de Vos, Astrid Marot, Christopher Doerig, Jean Henrion, Pierre Deltenre
DOI: http://dx.doi.org/10.1016/j.jhep.2016.04.031

Background & Aims
Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear. The aim of this study was to determine the impact of alcohol intake and viral eradication on the risk of hepatocellular carcinoma (HCC), decompensation of cirrhosis and death.

Methods
Data on alcohol intake and viral eradication were prospectively collected in 192 patients with compensated HCV-related cirrhosis.

Results
74 patients consumed alcohol (median alcohol intake: 15 g/day); 68 reached viral eradication. During a median follow-up of 58 months, 33 patients developed HCC, 53 experienced at least one decompensation event, and 39 died. The 5-year cumulative incidence rate of HCC was 10.6% (95% CI: 4.6–16.6) in abstainers vs. 23.8% (95% CI: 13.5–34.1) in consumers (p = 0.087), and 2.0% (95% CI: 0–5.8) vs. 21.7% (95% CI: 14.2–29.2) in patients with and without viral eradication (p = 0.002), respectively. The lowest risk of HCC was observed for patients without alcohol intake and with viral eradication (0%) followed by patients with alcohol intake and viral eradication (6.2% [95% CI: 0–18.4]), patients without alcohol intake and no viral eradication (15.9% [95% CI: 7.1–24.7]), and patients with alcohol intake and no viral eradication (29.2% [95% CI: 16.5–41.9]) (p = 0.009). In multivariate analysis, lack of viral eradication and alcohol consumption were associated with the risk of HCC (hazard ratio for alcohol consumption: 3.43, 95% CI: 1.49–7.92, p = 0.004). Alcohol intake did not influence the risk of decompensation or death.

Conclusions
Light-to-moderate alcohol intake increases the risk of HCC in patients with HCV-related cirrhosis. Patient care should include measures to ensure abstinence.

Lay summary
Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear. In this prospective study, light-to-moderate alcohol intake was associated with the risk of hepatocellular carcinoma in multivariate analysis. No patients who did not use alcohol and who reached viral eradication developed hepatocellular carcinoma during follow-up. The risk of hepatocellular carcinoma increased with alcohol intake or in patients without viral eradication and was highest when alcohol intake was present in the absence of viral eradication. Patients with HCV-related cirrhosis should be strongly advised against any alcohol intake. Patient care should include measures to ensure abstinence.

Abstract
Journal of Hepatology
September 2016 Volume 65, Issue 3, Pages 543–551