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Incidence and Risk Factors for Hepatocellular Carcinoma in Cirrhosis: the Multi-center Hepatocellular Carcinoma Early Detection Strategy (HEDS) Study. Gastroenterology Reddy, K. R., McLerran, D., Marsh, T., Parikh, N., Roberts, L. R., Schwartz, M., Nguyen, M. H., Befeler, A., Page-Lester, S., Tang, R., Srivastava, S., Rinaudo, J. A., Feng, Z., Marrero, J. A. 2023

Abstract

BACKGROUND AND AIMS: Worldwide, hepatocellular carcinoma (HCC) is a common malignancy. We aimed to prospectively determine the incidence and risk factors of HCC in a United States cohort.METHODS: The multi-center Hepatocellular Carcinoma Early Detection Strategy study of the National Institutes of Health prospectively enrolled patients with cirrhosis who underwent standard surveillance for HCC. Demographics, medical and family history, etiology of liver disease, and clinical features were evaluated for associations with HCC.RESULTS: Between 4/10/2013 and 12/31/2021, 1,723 patients were enrolled and confirmed eligible. During median follow up of 2.2 years (range: 0-8.7 years), there were 109 incident cases of HCC for an incidence rate of 2.4 per 100 person-years; 88 (81%) patients with very early/early BCLC stage (0, A), 20 (18%) intermediate stage (B), 1 (1%) unknown stage. Risk factor analyses were restricted to 1,325 patients, including 95 incident HCC, with at least 6 months of follow up. The majority were men (53.2%), obese or severely obese (median body mass index [BMI] 30.2 kg/m2), and white (86.3%); 42.0% had history of HCV infection, 20.7% had alcoholic liver disease (ALD), and 24.9% had nonalcoholic fatty liver disease (NAFLD). Fourteen risk factors for HCC were significant (p<0.05) in univariate analyses, and a multivariate subset was selected by stepwise logistic regression. The multivariate subset contained gender (p<0.001, male, OR=2.47, 95% C.I. 1.54-4.07), years with cirrhosis (p=0.004, OR=1.06, 95% C.I. 1.02-1.1), family history of liver cancer (p=0.02, yes, OR=2.69, 95% C.I. 1.11-5.86), age (per 5-years, p=0.02, OR=1.17, 95% C.I. 1.03-1.33), obesity (p=0.02, yes, OR=1.7, 95% C.I. 1.08-2.73), aspartate aminotransferase (log(1+AST), p=0.06, OR=1.54 95% C.I. 0.97-2.42), alpha-fetoprotein (log(1+AFP), p=0.07, OR=1.32, 95% C.I. 0.97-1.77), and albumin (p=0.10, OR=0.7, 95% C.I. 0.46-1.07).CONCLUSIONS: Thus far, this is the largest prospective and geographically diverse study of a United States cohort of patients with cirrhosis that validates known risk factors for HCC (gender, age, obesity, years with cirrhosis, family history of liver cancer, baseline AFP, albumin, and AST). The incidence of HCC was 2.4 % per 100 person years.

View details for DOI 10.1053/j.gastro.2023.06.027

View details for PubMedID 37429366