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Alcohol intake increases risk for HCC in patients with HCV-related cirrhosis

Alcohol consumption — including light-to-moderate — was associated with an increased risk for hepatocellular carcinoma among patients with hepatitis C virus infection-related cirrhosis, according to published findings.

“There is an increase in the risk of [hepatocellular carcinoma] according to alcohol intake and the lack of viral eradication,” Christophe Moreno, MD, of the department of gastroenterology, hepatopancreatology and digestive oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Belgium, and colleagues wrote.

The researchers prospectively collected and reviewed data related to alcohol intake, virus eradication, HCC occurrence, decompensated cirrhosis and mortality of 192 patients with HCV and compensated cirrhosis found in the Belgian Association for the Study of the Liver national registry of patients with HCV-related cirrhosis.

“Available data indicate that patients with HCV-related cirrhosis are still exposed to a risk of HCC after having reached viral eradiation. In addition, patients with SVR are exposed to a higher risk of death from liver-related causes than non-infected people. … We sought to determine the impact of alcohol intake and viral eradiation on the risk of complications in patients with HCV-related cirrhosis,” the researchers wrote.

Seventy-four patients consumed alcohol, with a median alcohol intake of 15 g per day, and 68 reached viral eradication of HCV.

During follow-up, 33 patients developed HCC, 53 experienced at least one decompensation event and 39 died. Of the patients who died, 28 deaths were due to liver-related causes.

In patients who consumed alcohol, the patients who did not develop HCC had a median alcohol intake of 10 g per day vs. 20 g per day for those who did develop HCC (P = .6), indicating any alcohol consumption was associated with an increased risk for HCC. Therefore, the researchers performed analyses in abstainers and in consumers regardless of the amount of alcohol they consumed.

The 5-year cumulative incidence rate for HCC was 10.6% in patients who abstained from alcohol (95% CI, 4.6-16.6) compared with 23.8% in patients who consumed alcohol (95% CI, 13.5-34.1) The 5-year cumulative incidence rate for HCC was 2% for patients who had viral eradication (95% CI, 0-5.8) compared with 21.7% of patients who did not (95% CI, 14.2-29.2).

The lowest risk for HCC was observed among patients who did not consume any alcohol and had viral eradication (0%), followed by patients who consumed alcohol and had viral eradication (6.2%; 95% CI, 0-18.4), patients who did not consume alcohol and had no viral eradication (15.9%; 95% CI, 7.1-24.7) and patients who consumed alcohol and had no viral eradication (29.2%; 95% CI, 16.5-41.9).

Multivariate analysis showed that the lack of viral eradication and alcohol consumption were associated with risk for HCC (HR = 3.43; 95% CI, 1.49-7.92).

Analysis showed the 5-year cumulative incidence rate for mortality was lowest in patients who consumed alcohol and had viral eradication (0%; P = .002) and lowest risk for liver-related mortality (0%; P = .016), compared with all other patients. The 5-year cumulative incidence rate for decompensated cirrhosis was lowest in patients who did not consume alcohol and viral eradication (2.9%; 95 CI, 0-8.7) compared with all other patients (P = .012).

Alcohol intake did not impact risk for decompensation or mortality, according to the research.

“Accordingly, patients with HCV-related cirrhosis should be strongly advised against any alcohol intake,” the researchers concluded. “Patient care should include measures to ensure abstinence.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.