Liver cancer surveillance likely unnecessary in patients with alcoholic cirrhosis

Issue: August 10, 2012

Patients with alcoholic cirrhosis have a higher risk for hepatocellular carcinoma, but the use of cancer surveillance in that population likely would have a minimal effect on mortality from the disease, according to the results of a cohort study in Denmark.

“It is generally accepted in the US and European hepatology communities that patients with alcoholic cirrhosis … should be offered hepatocellular carcinoma surveillance, although guidelines and recent reviews acknowledge that the exact hepatocellular carcinoma risk among patients with alcoholic cirrhosis is unknown,” researchers wrote in the study background.

In this study, researchers looked at data from all Danish citizens with first-time diagnosis of alcoholic cirrhosis between 1993 and 2005 to determine the rate of hepatocellular carcinoma (HCC) incidence and mortality.

The study included 8,482 patients who were alive 1 year post-cirrhosis diagnosis who did not have HCC. Of this group, 2% (n=169) eventually were diagnosed with HCC. At 5 years, the risk for HCC among this group of patients was 1% (95% CI, 0.8-1.3).

When examining mortality among this patient population, the researchers found that 67.6% of the total cohort died, with a greater number of deaths not associated with HCC. Specifically, the 5-year risk for death from HCC was 0.8%, making only 1.8% of the total deaths associated with that type of cancer.

“Although patients who develop HCC may benefit from earlier HCC diagnosis, our data suggest that patients with cirrhosis as a whole benefit only marginally from routine HCC surveillance,” the researchers wrote. “That benefit should be weighed against the costs and the risk for harm, which is greater in populations with low HCC risk because the chances of false-positive screening results are inversely correlated with HCC risk.”

Reference:

Jepsen P. Ann Intern Med. 2012;156:841-847.