Disease stage, biochemical response predicted HCC risk in primary biliary cirrhosis patients

BOSTON — While men are at higher risk for developing hepatocellular carcinoma among patients with primary biliary cirrhosis, known as PBC, disease stage and biochemical response can be used to further stratify the risk in this population, according to data presented at The Liver Meeting.

“Patient stratification is increasingly able to identify low- and high-risk groups to inform clinical practice, particularly as regards predicting outcome,” Gideon Hirschfield, MA, MB, PhD, Institute of Biomedical Research at the University of Birmingham, UK, told Healio Gastroenterology. “We show in this international study — using an international cohort of PBC that is unrivalled — that liver cancer risk in PBC can be stratified by liver biochemistry.”

Gideon Hirschfield

Palak J. Trivedi

Aiming to determine if HCC development can be effectively risk-stratified among men with PBC, Hirschfield, Palak J. Trivedi, BSc, MB, MRCP, and colleagues collected data on 4,565 patients with PBC (median follow-up, 7.1 years) from more than 15 liver centers in North America and Europe, accounting for more than 40 consecutive years of observation. In total, there were 123 cases of HCC.

The risk for developing HCC was higher in men compared with women overall (IR=6.7 vs. 2.6 cases per 1,000 patient years; HR=2.91; 95% CI, 1.9-4.8) and also among patients with advanced disease at diagnosis of PBC (HR=2.9; 95% CI; 95% CI, 1.6-5.32). Conversely, no significant gender differences were observed among patients with early-stage PBC (P=.49). While ursodeoxycholic acid was received by 84% of men compared with 85% of women (P=.75), stratifying for biochemical response demonstrated the highest HCC risk associated with male non-responders compared with male responders and female non-responders (P<.001).

Further risk stratification for HCC development among the high-risk male PCB patient population is effective using disease stage and biochemical response criteria.

“There is now clearer evidence that not only is biochemical stratification (based around the level of alkaline phosphatase measured in serum) important but gender is important,” Hirschfield said. “This mirrors other more common liver diseases in which men are stratified to be at higher risk of liver cancer. Our study therefore facilitates a more personalized approach to screen for complications of liver disease in PBC patients.” – by Adam Leitenberger

For more information:

Trivedi PJ. Abstract 281. Presented at: The Liver Meeting, Nov. 7-11, 2014; Boston, MA.

Disclosure: See the abstract for a full list of relevant financial disclosures.