Current trends indicate a rise in cirrhosis, HCC incidence

SAN FRANCISCO — According to data presented at The Liver Meeting 2015, a national retrospective study of Veterans Affairs patients showed increasing incidence rates for cirrhosis and hepatocellular carcinoma in the U.S. A majority of the increases are due to hepatitis C virus infection.

“The prevalence of cirrhosis is still rising, but appears to be leveling off. The burden of HCC is rising dramatically, with no sign of a slowdown,” Lauren A. Beste, MD, MSc, of the Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, and University of Washington, said in a press release. “HCV is driving these trends, with alcoholic liver disease and [nonalcoholic fatty liver disease] making up the majority of other cases.”

Beste and colleagues analyzed data of patients at the VA diagnosed with cirrhosis (n = 129,998) or HCC (n = 21,326) between 2001 and 2013.

Over the course of the study, cirrhosis incidence ranged from 159 to 193 per 100,000 patient-years. Deaths in patients with cirrhosis increased from 83 to 126 per 100,000 patient-years, largely due to HCV. The prevalence of cirrhosis doubled from 664 to 1,058 per 100,000 patients enrolled, most commonly due to HCV and NAFLD.

HCC incidence increased 2.5-fold from 17 to 45 per 100,000 patient-years and mortality tripled from 13 to 37 per 100,000 patient-years, largely due to HCV and smaller contributions from NAFLD and alcoholic liver disease, according to the research.

Among these increasing rates, HCV was present in 48% of cirrhosis cases and deaths and 67% of HCC cases and deaths by 2013.

Due to the fact that HCV, alcoholic liver disease and NAFLD are the drivers of these increases, according to Beste, means treating the alcoholic liver disease and NAFLD has become more of a challenge for some clinicians.

“HCV is an attractive target because it can be readily treated. The VA system, in particular, has mobilized an incredible effort to expand antiviral treatment to patients in need of it,” Beste said. However, delivering effective treatments for alcohol use disorders and NAFLD risk factors, like obesity, is a huge challenge for which the field doesn’t have immediate or easy solutions.”

Overall, the incidence rate for HCC increased by 265%, mortality in patients with HCC increased by 285% and mortality in patients with cirrhosis increased by 51% over the course of the study period.”

Beste concluded: “Our study shows that the burden of cirrhosis and particularly HCC will continue to increase for years to come. This will have important implications for the VA system and for the general U.S. population.” – by Melinda Stevens

Reference:

Dominitz JA, et al. Abstract 128. Presented at: The Liver Meeting; Nov. 13-17, 2015; San Francisco.

Disclosures: Beste reports no relevant financial disclosures. Please see the abstract for a full list of all other authors’ relevant financial disclosures.