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Risk of hepatocellular carcinoma among individuals with different aetiologies of cirrhosis: a population-based cohort study

West, J and Card, TR and Aithal, GP and Fleming, KM (2017) Risk of hepatocellular carcinoma among individuals with different aetiologies of cirrhosis: a population-based cohort study. Alimentary Pharmacology and Therapeutics, 45 (7). pp. 983-990. ISSN 0269-2813

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Abstract

Background: Among patients with cirrhosis, only those determined to be at risk for hepatocellular carcinoma (HCC) should undergo surveillance. However, little is known about how different aetiologies of cirrhosis affect risk for HCC.
Aim: To quantify the cumulative incidence of HCC among a representative population of people with cirrhosis of the liver of varying aetiology.
Methods: We identified subjects with hepatic cirrhosis from the UK's General Practice Research Database (1987–2006). Diagnoses of HCC were obtained from linked national cancer registries (1971–2006). Cox proportional hazards regression was used to estimate hazard ratios. The predicted 10-year cumulative incidence of HCC for each aetiology of cirrhosis was estimated while accounting for competing risks of death from any cause and liver transplant.
Results: Among 3107 people with cirrhosis, the adjusted relative risk of HCC was increased twofold to threefold among people with viral and autoimmune/metabolic aetiologies, compared to those with alcohol-associated cirrhosis. The 10-year predicted cumulative incidence estimates of HCC for each aetiology were alcohol, 1.2%; chronic viral hepatitis, 4.0%; autoimmune or metabolic disease, 3.2%; and cryptogenic, 1.1%.
Conclusions: In a population-based study in the UK, people with cirrhosis have an estimated cumulative 10-year incidence of HCC of 4% or lower. Cumulative incidence varies with aetiology such that individuals with alcohol or cryptogenic cirrhosis have the lowest risk for HCC. These findings provide important information for cost-effectiveness analyses of HCC surveillance.

Item Type: Article
Additional Information: This is the accepted version of the following article: West, J., Card, T. R., Aithal, G. P. and Fleming, K. M. (2017), Risk of hepatocellular carcinoma among individuals with different aetiologies of cirrhosis: a population-based cohort study. Aliment Pharmacol Ther, 45: 983–990. doi:10.1111/apt.13961, which has been published in final form at http://dx.doi.org/10.1111/apt.13961
Uncontrolled Keywords: 1103 Clinical Sciences, 1115 Pharmacology And Pharmaceutical Sciences
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions: Public Health Institute
Publisher: Wiley
Related URLs:
Date Deposited: 27 Apr 2017 08:41
Last Modified: 12 Sep 2017 06:23
DOI or Identification number: 10.1111/apt.13961
URI: http://researchonline.ljmu.ac.uk/id/eprint/6305

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