Incidence and Risk Factors for Hepatocellular Carcinoma in Primary Biliary Cirrhosis

Abstract

The incidence, risk factors, and clinical features of hepatocellular carcinoma (HCC) in primary biliary cirrhosis (PBC) have been a long-standing subject of interest. We took advantage of a large cohort of 1865 well-defined Chinese patients with PBC for whom follow-up was conducted for up to 20 years to study the incidence of HCC. Our goal was to address the incidence and prevalence of HCC in PBC and the risk factors, including hepatitis B virus (HBV) infection, and finally to compare the tumor characteristics of PBC-related HCC, including size, location, mortality, and long-term outcomes, to that of HBV-related HCC. In this cohort, HCC occurred in 70 of 1865 PBC patients with a prevalence of 3.75 % and an incidence of 0.66 cases per 100 patient-years. The 5- and 10-year cumulative incidences were 2.6 % (95 % confidence interval (CI) 1.8-3.4) and 8.9 % (95 % CI 5.5-12.3), respectively. Age >54 years (odds ratio [OR] = 5.5, 95 % CI 3.0-10.1, p = 0.001), male sex (OR = 2.2, 95 % CI 1.2-4.0, p = 0.001), co-existence of diabetes mellitus (DM) (OR = 3.1, 95 % CI 1.6-6.2, p = 0.002), and previous HBV infection (OR = 6.6, 95 % CI 3.7-11.9, p = 0.001) were independently associated with the development of HCC. The tumor size, number, location, and 5-year survival were not significantly different in PBC-related HCC compared to HBV-related HCC. Alpha-fetoprotein was elevated in only 20 % of the cases with PBC-related HCC. Although HCC was uncommon, occurring in fewer than 5 % of patients, the risk is significantly increased by age, sex, DM, and past HBV infection.

The Natural History and Prognosis of Primary Biliary Cirrhosis with Clinical Features of Autoimmune Hepatitis

“…There have been extraordinary and extensive studies of the genetic basis, the immunological features, and the molecular characteristics of not only human PBC but also of several mouse models [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Geoepidemiology and changing mortality in primary biliary cholangitis

“…A large cohort of 1865 well-defined Chinese patients with PBC were evaluated for the incidence of HCC up to 20 years. HCC occurred in less than 5% of patients, but the risk was significantly increased by increased age, male sex, diabetes mellitus, and previous hepatitis B virus infection [46]. In another large cohort in Japan, the HCC incidence was 2.4% (71/2946), and male sex and advanced histological stage in females are independent risk factors for the development of HCC in patients with PBC [45].…”

“…A recent study conducted by [44]. The role of male sex in the development of HCC in PBC has also been found in a representative cohort of Chinese and Japanese patients with a long follow-up [45,46]. A large cohort of 1865 well-defined Chinese patients with PBC were evaluated for the incidence of HCC up to 20 years.…”

Autoimmune Diseases of Digestive System

“…Так, по данным Rong и соавт. [36], распространенность ГЦК у пациентов с ПБЦ составляет 3,75%, а частота -0,66 случаев на 100 пациенто-лет. При этом пяти-и де-сятилетняя кумулятивная частота ГЦК была равна 2,6 (95% ДИ 1,8-3,4) и 8,9% (95% ДИ 5,5-12,3), соответ-ственно.…”

“…Обсуждается возможное значение в патогенезе болезни каталазы -фермента, участвующего в расщеплении пе-роксида водорода с образованием воды и молекулы кис-лорода, а также α-энолазы -фермента, участвующего в реакциях гликолиза. Кроме того, у пациентов с ПСХ мо-гут определяться ANA (8-77%) и ASMA (0-83%) [18,36].…”