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US veterans have increased frequency of HCC at autopsy

United States military veterans had an increased frequency of hepatocellular carcinoma at autopsy compared with the general population, according to recent findings published in Clinical Gastroenterology and Hepatology.

“We performed a single institution autopsy study on a cohort of U.S. veterans and found a markedly increased frequency of primary liver tumors compared to the general U.S. population,” Aqsa Nasir, MD, in the department of pathology and laboratory medicine at the University of Minnesota School of Medicine, told Healio.com/Hepatology. “Significant risk factors identified were chronic hepatitis C and liver cirrhosis.”

Aqsa Nasir

The ratio of metastatic to primary malignant liver tumors is 40:1 in the U.S. and less than 1 in southeast Asia, the researchers wrote. These variations are most likely due to differences in tumor incidence.

Nasir and colleagues performed a study of male U.S. veterans using electronic medical records of 405 autopsies performed between 2005 and 2014. The researchers obtained liver cancer risk factors from electronic medical records, including BMI at autopsy and in the previous 3 years.

The researchers found that 11% of the veterans had malignant tumors, 78% had metastatic tumors and 22% had primary tumors. The ratio of metastatic to primary tumor was 3.5:1. The average age at diagnosis was 66.3 years for the metastatic cohort and 69.5 years for the primary cohort. Thirty-nine percent of the metastatic tumors were located in the lungs, 19% in the pancreas and 8% were colorectal. Nineteen percent of metastatic cancers were adenocarcinoma, 14% were small cell carcinoma, 11% were pulmonary squamous cell carcinoma and 11% were colonic adenocarcinoma. Sixty percent of the primary tumors were HCC and 30% were mixed hepatocellular/cholangiocarcinoma. Risk factors for primary tumors were cirrhosis (OR = 18.7; 95% CI, 3.4-102.8) and chronic hepatitis (OR = 16.5; 95% CI, 2.9-93.2). There was an increased rate of steatohepatitis in the primary tumor cohort, however there was no increased risk. There were no increased rates of alcohol abuse, smoking, diabetes mellitus or BMI. In the cirrhosis cohort, 60% had cirrhosis that was associated with hepatitis C and all cases were negative for hepatitis B.

These results are consistent with a recent retrospective study that reported a 2.5-fold increase in HCC in veterans from 2001 to 2013, mostly attributable to hepatitis C, the researchers wrote.

“Given the increased rate of steatohepatitis, and high rates of alcohol abuse in both cohorts, it is likely that most of these cases represent alcoholic cirrhosis,” the researchers wrote. “Epidemiologic studies have shown 2.5-fold lifetime prevalence of alcoholism in veterans compared to non-veterans.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.