Features of hepatocellular carcinoma in cases with autoimmune hepatitis and primary biliary cirrhosis

Abstract

AIM:To c h a ra c t e r i z e t h e c l i n i c a l f e a t u r e s o f hepatocellular carcinoma (HCC) associated with autoimmune liver disease, we critically evaluated the literature on HCC associated with autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC). METHODS:A systematic review of the literature was conducted using the Japana Centra Revuo Medicina database which produced 38 cases of HCC with AIH (AIH-series) and 50 cases of HCC with PBC (PBCseries). We compared the clinical features of these two sets of patients with the general Japanese HCC population. RESULTS:On average, HCC was more common in men than in women with AIH or PBC. While many patients underwent chemolipiodolization (CL) or transcatheter arterial embolization (TAE) (AIH-series: P = 0.048 (vs operation), P = 0.018 (vs RFA, PEIT); PBC-series: P = 0.027 (vs RFA, PEIT), others refused therapeutic interventions [AIH-series: P = 0.038 (vs RFA, PEIT); PBC-series: P = 0.003 (vs RFA, PEIT)].Liver failure was the primary cause of death among patients in this study, followed by tumor rupture. The survival interval between diagnosis and death was fairly short, averaging 14 ± 12 mo in AIH patients and 8.4 ± 14 mo in PBC patients. CONCLUSION:We demonstrated common clinical features among Japanese cases of HCC arising from AIH and PBC.

Development of Hepatocellular Carcinoma in Autoimmune Hepatitis Patients: A Case Series

“…This study emphasized previous reports on the low prevalence of HCC among patients with AIH [3][4][5][6][7][8][9][10][11][12][13][14][15]. However, the development of malignancy does occur and the clinical sequelae associated with this concurrent diagnosis leads to significant morbidity and mortality.…”

“…While AIH patients with cirrhosis is associated with great neoplastic potential, another study among Japanese patients only demonstrated cirrhosis in half of AIH patients with HCC. However, AIH patients that developed HCC had significantly greater mortality regardless of cirrhosis status [7]. In our study cohort, the prevalence of HCC among AIH patients with documented cirrhosis was significantly higher than the overall cohort (1,920 HCC cases per 100,000 patient-years or 1.9% per year).…”

“…The impact of gender on HCC risk has also been an area of detailed analyses. Overall, males have higher rates of HCC than females and a recent study from Japan demonstrated greater HCC risk among male patients with AIH compared with females [7,33]. While these differences may reflect gender variations in risk factors with malignancy potential (tobacco smoking, alcohol consumption, exposure to viral hepatitis through high risk behaviors), the higher rates of HCC among males persists even when evaluating disease-specific cancer incidence.…”

“…While AIH with cirrhosis is often grouped with other diseases that have a clear association with increased risk of malignancy, the true incidence of HCC among this group is poorly described [3][4][5][6][7][8][9][10][11][12]. Prospective studies have reported a greater than 40-50% rate of progression to cirrhosis over 15 years among untreated AIH patients [13,14].…”

Hepatocellular Carcinoma – Epidemiological Trends and Risk Factors

“…Until now only a small number of patients with HCC in the setting of autoimmune liver disease have been identified in whom other causes of liver cirrhosis have been excluded [102,103] . Autoimmune hepatitis (AIH) progresses to cirrhosis which seems to be the sine qua non for HCC development in this setting with an annual rate of 1.1% in male and female patients [104] .…”