Liver and Bile
Hepatology. 2023;77(3):997–1005
Risk factors for HCC in contemporary cohorts of patients with cirrhosis
Background and aims: Etiological risk factors for cirrhosis have changed in the last decade. It remains unclear to what extent these trends in cirrhosis risk factors have changed the risk of hepatocellular carcinoma (HCC).
Approach and results: The authors used data from 2 contemporary, prospective multiethnic cohorts of patients with cirrhosis: the Texas Hepatocellular Carcinoma Consortium Cohort and the Houston Veterans Administration Cirrhosis Surveillance Cohort. Patients with cirrhosis were enrolled from 7 US centers and followed until HCC diagnosis, transplant, death, or June 30, 2021. The annual incidence rates for HCC were calculated and the effects of etiology, demographic, clinical, and lifestyle factors on the risk of HCC were examined. The authors included 2733 patients with cirrhosis (mean age 60.1 years, 31.3% women). At enrollment, 19.0% had active hepatitis C virus (HCV), 23.3% had cured HCV, 16.1% had alcoholic liver disease (ALD), and 30.1% had non-alcoholic fatty liver disease (NAFLD). During 7406 person-years of follow-up, 135 patients developed HCC at an annual incidence rate of 1.82% (95% confidence interval [CI]: 1.51–2.13). The annual HCC incidence rate was 1.71% in patients with cured HCV, 1.32% in patients with ALD, and 1.24% in patients with NAFLD cirrhosis. Compared to patients with NAFLD, the risk of progression to HCC was 2-fold higher in patients with cured HCV (hazard ratio [HR] = 2.04; 95% CI: 1.24–3.35). Current smoking (HR = 1.63; 95% CI: 1.01–2.63) and overweight/obesity (HR = 1.79; 95% CI: 1.08–2.95) were also associated with HCC risk.
Conclusions: Hepatocellular carcinoma (HCC) incidence among patients with cirrhosis was lower than previously reported. HCC risk was variable across etiologies, with higher risk in patients with hepatitis C virus cirrhosis and lower risk in those with non-alcoholic fatty liver disease cirrhosis. Current smoking and overweight/obesity increased HCC risk across etiologies.