Epidemiology

Alcohol increases liver cancer risk in HBV cirrhosis

Last Updated: 2012-12-21 16:20:13 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Heavy alcohol consumption significantly increases the risk of hepatoma in cirrhotic patients with hepatitis B virus (HBV) infection, say researchers from Taiwan.

But treatment with antiviral nucleos(t)ides analogues significantly reduce that risk, coauthor Dr. Sien-Sing Yang told Reuters Health by email.

In a December 7th online paper in the Journal of Hepatology, Dr. Yang of Cathay General Hospital, Taipei and colleagues wrote that the interplay between HBV infection, alcohol, and clinical outcomes has been reported - but the influence of alcohol on the development of hepatocellular carcinoma (HCC) remains uncertain.

To investigate further, the team followed 966 cirrhotic patients, including 202 with alcoholic liver disease, 132 with alcoholic liver disease and HBV infection, and 632 with HBV alone.

All of the patients with alcoholic liver disease had "heavy alcoholism," defined by the authors consumption of more than 80 g of ethanol daily for at least five years.

The primary end point -- newly developed HCC after six month's follow-up - occurred in 28.8% of the HBV alcoholics, 5.8% of the HBV-only group, and 10.4% of the alcoholic-only group. The corresponding annual incidences were 9.9%, 4.1%, and 2.1%, respectively, and the cumulative rates at 10 years were 52.8%, 39.8% and 25.6%.

HBV alcoholics developed HCC at a younger age than subjects in the other two groups (43.9 vs 47.8 vs 49.3 years).

The cumulative incidence of HCC was higher in patients with higher baseline serum HBV DNA. Antiviral nucleos(t)ides analogue therapy reduced the incidence of HCC in cirrhotic patients with HBV infection and alcoholism, however. The cumulative incidence of HCC at nine years was about twice as high in patients with high HBV DNA who did not receive this therapy compared to those who did (80% vs 40%).

"The synergism between alcoholism and HBV infection leads to more severe liver disease and earlier occurrence of HCC," the investigators conclude. "Therefore, alcoholic cirrhotic patients with concomitant HBV infection should be closely screened for HCC" and encouraged to abstain from alochol.

In addition, they add "aggressive antiviral nucleos(t)ides analogues therapy should be considered."

SOURCE: http://bit.ly/Wvd914

J Hepatol 2012.