Alcohol use and hepatocellular carcinoma risk in patients with alcohol-related cirrhosis

Abstract

Objectives

Insights into risk factors for hepatocellular carcinoma (HCC) among patients with alcohol-related cirrhosis (ALD cirrhosis) are important for decisions about HCC surveillance. We studied the effects of continued hazardous alcohol use in ALD cirrhosis on HCC risk.

Methods

Within a nationwide registry-based cohort of patients with ALD cirrhosis, we compared HCC risk between patients with a continued hazardous alcohol use and matched comparators. We used Fine-Gray regression to compare the risk of HCC and Cox regression to compare all-cause mortality. We also included patients with ALD cirrhosis in a clinical case-control study. Cases had HCC, and controls did not. Alcohol use was quantified using the AUDIT-C-questionnaire. Logistic regression was used to analyze the association between hazardous alcohol use and HCC risk.

Results

In the registry-based study, we included 8,616 patients with continued hazardous alcohol use and 8,616 matched comparators. Patients with a continued hazardous alcohol use had a lower HCC risk (subdistribution hazard ratio: 0.64, 95% confidence interval [CI]: 0.57 − 0.72) and higher mortality (hazard ratio: 1.62, 95% CI: 1.56 − 1.67). In the clinical study, we included 146 patients with ALD cirrhosis of whom 53 had newly diagnosed HCC. Hazardous alcohol use was insignificantly associated with a lower HCC risk (odds ratio: 0.61, 95% CI: 0.25 − 1.46).

Conclusions

Hazardous alcohol use in patients with ALD cirrhosis is associated with higher mortality and, consequently, a lower HCC risk. Even if alcohol is carcinogenic, HCC surveillance will therefore likely be more effective in patients with ALD cirrhosis without a hazardous alcohol use.

Keywords:

• Alcoholism
• liver cirrhosis
• hepatocellular carcinoma
• early detection of cancer
• public health

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data used in this study cannot be made publicly available according to Danish law. Access to data from the Danish healthcare registries can be applied via https://sundhedsdatastyrelsen.dk/da/forskerservice.

Additional information

Funding

Peter Jepsen was supported by a grant from the Novo Nordisk Foundation [NNF18OC0054612]. The funding organization was not involved in the design and conduct of the study, or in the decision to submit the manuscript for publication. All other authors report no financial support.