Fattovich G, Stroffolini T, Zagni I, Donato F.
Department of Gastroenterology, University of Verona, Verona, Italy. giovanna_fattovich@tin.it
Emerging data indicate that
the mortality rate of hepatocellular carcinoma (HCC) associated with cirrhosis
is rising in some developed countries, whereas mortality from non-HCC complications
of cirrhosis is decreasing or is stable. Cohort studies indicate that HCC is
currently the major cause of liver-related death in patients with compensated
cirrhosis. Hepatitis C virus (HCV) infection is associated with the highest
HCC incidence in persons with cirrhosis, occurring twice as commonly in Japan
than in the West (5-year cumulative incidence, 30% and 17%, respectively), followed
by hereditary hemochromatosis (5-year cumulative incidence, 21%). In hepatitis
B virus (HBV)-related cirrhosis, the 5-year cumulative HCC risk is 15% in high
endemic areas and 10% in the West. In the absence of HCV and HBV infection,
the HCC incidence is lower in alcoholic cirrhotics (5-year cumulative risk,
8%) and subjects with advanced biliary cirrhosis (5-year cumulative risk, 4%).
There are limited data on HCC risk in cirrhosis of other causes. Older age,
male sex, severity of compensated cirrhosis at presentation, and sustained activity
of liver disease are important predictors of HCC, independent of etiology of
cirrhosis. In viral-related cirrhosis, HBV/HCV and HBV/HDV coinfections increase
the HCC risk (2- to 6-fold relative to each infection alone) as does alcohol
abuse (2- to 4-fold relative to alcohol abstinence). Sustained reduction of
HBV replication lowers the risk of HCC in HBV-related cirrhosis. Further studies
are needed to investigate other viral factors (eg, HBV genotype/mutant, occult
HBV, HIV coinfection) and preventable or treatable comorbidities (eg, obesity,
diabetes) in the HCC risk in cirrhosis.
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