Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 May;21(5):1169-1177.
doi: 10.1016/j.cgh.2022.06.032. Epub 2022 Aug 5.

Hepatocellular Carcinoma Incidence in Alcohol-Associated Cirrhosis: Systematic Review and Meta-analysis

Daniel Q Huang  1 , Darren J H Tan  2 , Cheng Han Ng  2 , Maral Amangurbanova  3 , Nancy Sutter  3 , Phoebe Wen Lin Tay  2 , Wen Hui Lim  2 , Jie Ning Yong  2 , Ansel Tang  2 , Nicholas Syn  2 , Mark D Muthiah  4 , Eunice X X Tan  4 , Shravan Dave  3 , Benjamin Tay  5 , Abdul M Majzoub  6 , Danielle Gerberi  7 , Beom Kyung Kim  8 , Rohit Loomba  9
Affiliations
Review

Hepatocellular Carcinoma Incidence in Alcohol-Associated Cirrhosis: Systematic Review and Meta-analysis

Daniel Q Huang et al. Clin Gastroenterol Hepatol. 2023 May.

Abstract

Background & aims: Alcohol is one of the leading causes of hepatocellular carcinoma (HCC). However, pooled estimates of HCC incidence in alcohol-associated cirrhosis have not been evaluated systematically. We performed a pooled analysis of time-to-event data to provide robust estimates for the incidence of HCC in alcohol-associated cirrhosis.

Methods: Medline, Embase, Cochrane Central Register, Scopus, and Web of Science were searched from inception to August 2021. Individual patient data were reconstructed from published Kaplan-Meier curves, and a pooled analysis of cumulative HCC incidence was performed using a random-effects model.

Results: We screened 5022 articles and included 18 studies (148,333 patients). In the pooled analysis, the cumulative incidence of HCC in alcohol-associated cirrhosis at 1, 5, and 10 years among studies that accounted for the competing risk of death without HCC was 1%, 3%, and 9%, respectively. A secondary analysis by traditional meta-analysis determined that the HCC incidence rate was higher in cohorts enrolled in a HCC surveillance program (18.6 vs 4.8 per 1000 person-years; P = .001) vs those who were not enrolled in a surveillance program. Meta-regression showed that diabetes, smoking, variceal bleeding, and hepatic decompensation were associated with a higher risk of HCC.

Conclusions: Our analysis determined that the 5- and 10- year cumulative risk of HCC in alcohol-associated cirrhosis was 3% and 9%, respectively, with a higher incidence in cohorts that were enrolled in a HCC surveillance program. These data should be validated further in large prospective studies, and may have important implications for HCC screening and surveillance among patients with alcohol-associated cirrhosis.

Keywords: Alcohol; Cirrhosis; Hepatocellular Carcinoma; Incidence.

PubMed Disclaimer

Conflict of interest statement

These authors disclose the following: Daniel Q. Huang has received funding support from the Singapore Ministry of Health’s National Medical Research Council under its National Medical Research Council (NMRC) Research Training Fellowship (MOH-000595-01).

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of included articles. HCC, hepatocellular carcinoma.
Figure 2.
Figure 2.
Cumulative risk of hepatocellular carcinoma (HCC) among patients with alcohol-associated cirrhosis among studies that accounted for competing risk of death without HCC, by reconstructed individual patient data meta-analysis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Singal AK, Mathurin P. Diagnosis and treatment of alcohol-associated liver disease: a review. JAMA 2021;326:165–176. - PubMed
    1. Crabb DW, Im GY, Szabo G, et al. Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance from the American Association for the Study of Liver Diseases. Hepatology 2020;71:306–333. - PubMed
    1. Seitz HK, Bataller R, Cortez-Pinto H, et al. Alcoholic liver disease. Nat Rev Dis Primers 2018;4:16. - PubMed
    1. Mathurin P, Bataller R. Trends in the management and burden of alcoholic liver disease. J Hepatol 2015;62:S38–S46. - PMC - PubMed
    1. European Association for the Study of the Liver. EASL clinical practice guidelines: management of alcohol-related liver disease. J Hepatol 2018;69:154–181. - PubMed

MeSH terms