It is well known that people with liver cirrhosis have an elevated rate of hepatocellular carcinoma (HCC), but the prevalence of other types of cancer in this population has not been extensively studied.

What is Hepatocellular Carcinoma? Most primary liver cancers are classified as hepatocellular carcinoma. Hepatocellular carcinoma is a malignant tumor composed of cells resembling hepatocytes ; however, the resemblance varies with the degree of differentiation . Hepatocellular carcinoma is commonly associated with cirrhosis

At the recent Digestive Disease Week 2006 conference in Los Angeles, researchers reported on a study looking at the association between liver cirrhosis, HCC, and other cancers.

The analysis included all consecutive patients diagnosed with liver cirrhosis for the first time between 1994 and 2005 in Gothenburg, Sweden, a city of 600,000 inhabitants. The cumulative incidence of malignancies in this group was compared with the known incidence rates for the Swedish population as a whole.

Results

• 1016 patients were diagnosed with liver cirrhosis during the study period; 69% were men and the mean age was 60 years.
• Alcoholic liver disease was the most common cause of cirrhosis (45%), followed by hepatitis C (10%) and concurrent alcoholic liver disease plus hepatitis C (11%)
• 19% of liver cirrhosis cases were due to other causes, and 16% were cryptogenic (of unknown etiology).
• During a median follow-up period of 19 months (range 0-118), 86 cirrhotic patients overall (8.5%) developed HCC.
• HCC occurred in 27 out of 452 patients (6%) with alcoholic liver disease, 17 out of 102 (17%) with hepatitis C, 16 out of 115 (14%) with both, and 26 out of 347 other patients (7%).
• 45 patients overall (4.4%) developed other types of cancer, the most common being:
• colon cancer in 11 patients (24%)
• lung cancer in 4 (9%)
• pancreatic cancer in 4 (9%)
• prostate cancer in 3 (7%)
• uterine cancer in 3 (7%)
• other cancers in 20 (44%)
• The total number of malignancies among cirrhotic patients -- 131 out of 1016 or 13% -- was higher than the 10.7% cancer incidence rate in the general Swedish population (P = 0.017).
• The incidence of colon cancer was also higher among cirrhotic patients compared with the general population (1.1% vs 0.4%; P = 0.002).
• No significant difference was observed in the incidence of total cancers or colon cancer among patients with different cirrhosis etiologies.
• The median transplant-free survival time for patients with HCC was 8 months (IQR 2-24); median survival for patients with other cancers was 12 months (IQR 2-36).
• The transplant-free 5-year survival rate was 4% for patients with HCC and 5% for the patients with other cancers.
• 9% of patients with HCC received liver transplants.
• 74 patients (86%) with HCC died during follow-up, compared with 42 patients  (93%) with other cancers.
• Cancer was the cause of death in 85% of patients with HCC and 79% of patients with other cancers.

Conclusion

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The researchers concluded that HCC in cirrhotic patients was most commonly associated with hepatitis C, and that the cause of cirrhosis did not seem to have a major impact on the risk of other types of cancer. They added that both HCC and non-liver cancer in cirrhotic patients carries a very poor prognosis.

6/23/06

Reference
SA Gunnarsdottir, E Kalaitzakis, and E Bjornsso. The occurrence of malignancy in patients with liver cirrhosis -- more than HCC. Abstract M1032. Digestive Disease Week 2006. May 20-25, 2006. Los Angeles, CA.

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