Factors associated with unrecognized cirrhosis in patients with hepatocellular carcinoma

Abstract

Background: Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and can go undiagnosed for years, leading to underuse of HCC surveillance in clinical practice. We characterized the frequency and associated factors of unrecognized cirrhosis in a national sample of patients with HCC from the United States.Methods: HCC patients aged 68 years and older, diagnosed during 2011 to 2015 were included from the SEER-Medicare Linked Database. If cirrhosis was diagnosed within 6 months immediately preceding HCC diagnosis or after HCC diagnosis, cases were categorized as unrecognized cirrhosis.Factors associated with unrecognized cirrhosis were identified using logistic regression analyses.Factors associated with overall survival were evaluated using Cox regression analyses.Results: Among 5,098 HCC patients, 74.8% patients had cirrhosis. Among those with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR: 2.12, 95% CI: 1.83-2.46), non-Hispanic Black race (aOR:1.93, 95%CI: 1.45-2.57), and NAFLD etiology (aOR:4.46, 95% CI:3.68-5.41) were associated with having unrecognized cirrhosis. Among NAFLD-related HCC patients, male sex (aOR:2.32, 95% CI:1.71-3.14) was associated with unrecognized cirrhosis. Unrecognized cirrhosis was independently associated with worse overall survival (aHR:1.17, 95% CI:1.08-1.27) compared to recognized cirrhosis. Conclusion: Unrecognized cirrhosis is common in NAFLD-related HCC, particularly among male andBlack patients, highlighting these groups as important intervention targets to improve HCC surveillance uptake and outcomes. HIGHLIGHTCirrhosis is the most important risk factor of HCC; however, early cirrhosis is often undiagnosed. We characterized factors associated with unrecognized cirrhosis in a national sample of HCC patients from the United States. Among HCC patients with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR:2.12, 95%CI:1.83-2.46), non-Hispanic Black race (aOR:1.93, 95%CI:1.45-2.57), and NAFLD etiology (aOR:4.46, 95%CI:3.68-5.41) were associated with having unrecognized cirrhosis. Unrecognized cirrhosis was associated with worse survival (aHR:1.17, 95%CI:1.08-1.27) compared to recognized cirrhosis. Our findings suggest these groups as important intervention targets to improve HCC surveillance uptake.

Exploring the factors affecting the occurrence of postoperative MVI and the prognosis of hepatocellular carcinoma patients treated with hepatectomy: A multicenter retrospective study

“…This distortion will cause portal hypertension and hepatic synthetic dysfunction 10 . The most significant risk factor for HCC, according to studies, 11 is hepatocirrhosis of any cause, and in Western countries, more than 90% of HCC patients had hepatocirrhosis as an underlying condition. Savio G. Barreto et al.…”

“…This distortion will cause portal hypertension and hepatic synthetic dysfunction. 10 The most significant risk factor for HCC, according to studies, 11 is hepatocirrhosis of any cause, and in Western countries, more than 90% of HCC patients had hepatocirrhosis as an underlying condition. Savio G. Barreto et al showed that hepatocirrhosis and MVI are important prognostic influences that jointly affect the prognosis of patients with HCC undergoing surgical resection, and that cirrhotic HCC patients also contribute to the formation of MVI due to concomitant repetitive inflammation and necrotic cell death, resulting in enhanced proliferation and the accelerated development of new HCC foci.…”

Risk factors associated with late hepatocellular carcinoma detection in patients undergoing regular surveillance

“…This outcome may have resulted from HCC occurring in non-cirrhotic livers. Although HCC typically develops in the liver with a cirrhotic background, [13,14] approximately 20% of HCC cases arises in non-cirrhotic livers. [15] In particular, NASH-related HCCs occur in both underlying cirrhotic and non-cirrhotic underlying livers.…”