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

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Abstract

Background

The risk of hepatocellular carcinoma (HCC) among patients with autoimmune hepatitis (AIH) is believed to be low compared with other chronic liver diseases, and uncertainty exists over the need to perform HCC surveillance. If surveillance is initiated, the optimal timing is also not yet defined.

Aims

The aim of the study was to investigate the prevalence of HCC among AIH patients.

Methods

This was a retrospective study analyzing patient data from 1999 to 2009 in a large tertiary-care community hospital to assess the prevalence of HCC among AIH patients.

Results

Among 322 AIH cases, cancer screening identified six patients that developed HCC (prevalence: 459 per 100,000 patient-years). All six patients were extracted from the subset of AIH patients with cirrhosis (n = 50), resulting in a prevalence of 1,920 per 100,000 patient-years. In the AIH with HCC cohort, mean age of AIH diagnosis was 51.8 years (range, 24–70) and mean age of HCC diagnosis was 60.0 years (range, 37–71). The mean interval between diagnosis of AIH and HCC was 10.0 years. Three patients had AJCC stage ≥2 cancer at diagnosis, and two had BCLC stage B or C.

Conclusions

The risk of HCC among AIH patients with cirrhosis is 1.9% per year. This is comparable to HCC risk among patients with cirrhosis secondary to HBV, HCV, hemochromatosis, or alcohol-related liver disease. Although this data needs to be confirmed in prospective studies, routine cancer screening and surveillance among this cohort for early detection and treatment should be conducted.

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References

  1. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–1236.

    Article  PubMed  Google Scholar 

  2. Ryder SG. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (HCC) in adults. Gut. 2003;53(Suppl. III):iii1–iii8.

    Google Scholar 

  3. Wang KK, Czaja AJ. Hepatocellular carcinoma in corticosteroid treated severe autoimmune chronic active hepatitis. Hepatology. 1988;8:1679–1683.

    Article  CAS  PubMed  Google Scholar 

  4. Park SZ, Nagorney DM, Czaja AJ. Hepatocellular carcinoma in autoimmune hepatitis. Dig Dis Sci. 2000;45:1944–1948.

    Article  CAS  PubMed  Google Scholar 

  5. Hardee JT, Breth GF, El-Serag HB. Hepatocellular carcinoma associated with autoimmune hepatitis. J Clin Gastroenterol. 2000;30:445–446.

    Article  Google Scholar 

  6. Teufel A, Weinmann A, Centner C, et al. Hepatocellular carcinoma in patients with autoimmune hepatitis. World J Gastroenterol. 2009;15:578–582.

    Article  PubMed  Google Scholar 

  7. Watanabe T, Soga K, Hirono H, et al. Features of hepatocellular carcinoma in cases with autoimmune hepatitis and primary biliary cirrhosis. World J Gastroenterol. 2009;15:231–239.

    Article  PubMed  Google Scholar 

  8. Ryder SD, Koskonas J, Rizzi PM. Hepatocellular carcinoma complicating autoimmune hepatitis: role of hepatitis C virus. Hepatology. 1995;22:718–722.

    CAS  PubMed  Google Scholar 

  9. Hori K, Fukada Y, Tomita T. Hepatocellular carcinoma complicating autoimmune hepatitis without either hepatitis C viral infection or corticosteroid therapy. J Gastroenterol. 2003;38:197–199.

    Article  PubMed  Google Scholar 

  10. Miyake Y, Sakaguchi K, Tanaka H. Development of hepatocellular carcinoma in a woman with HBV and HCV-negative autoimmune hepatitis with unsatisfactory response to corticosteroid. Intern Med. 2005;44:949–953.

    Article  PubMed  Google Scholar 

  11. Montano-Loza AJ, Carpenter HA, Czaja AJ. Predictive factors of hepatocellular carcinoma in type 1 autoimmune hepatitis. Am J Gastroenterol. 2008;103:1944–1951.

    Article  CAS  PubMed  Google Scholar 

  12. Yeoman AD, Al-Chalabi T, Karani JB, et al. Evaluation of risk factors in the development of hepatocellular carcinoma in autoimmune hepatitis: implications of follow-up and screening. Hepatology. 2008;48:863–870.

    Article  PubMed  Google Scholar 

  13. Manns MP, Czaja AJ, Gorham JD, et al. Diagnosis and management of autoimmune hepatitis. Hepatology. 2010;51:2193–2223.

    CAS  PubMed  Google Scholar 

  14. Czaja AJ. Understanding the pathogenesis of autoimmune hepatitis. Am J Gastroenterol. 2001;96:1224–1231.

    Article  CAS  PubMed  Google Scholar 

  15. Chiaramonte M, Stroffolini T, Vian A, et al. Rate of incidence of hepatocellular carcinoma in patients with compensated viral cirrhosis. Cancer. 1999;85:2132–2137.

    Article  CAS  PubMed  Google Scholar 

  16. Chen CJ, Yang HI, Su J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295:65–73.

    Article  CAS  PubMed  Google Scholar 

  17. Jones D, Metcalf J, Collier J, Bassendine MF, James OF. Hepatocellular carcinoma in primary biliary cirrhosis and its impact on outcomes. Hepatology. 1997;26:1138–1142.

    Article  CAS  PubMed  Google Scholar 

  18. El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132:2557–2576.

    Article  CAS  PubMed  Google Scholar 

  19. Al-Chalabi T, Underhill JA, Portmann BC, McFarlane IG, Heneghan MA. Impact of gender on the long term outcome and survival of patients with autoimmune hepatitis. J Hepatol. 2008;48:140–147.

    Article  CAS  PubMed  Google Scholar 

  20. Alvarez F, Berg PA, Bianchi FB, et al. International Autoimmune Hepatitis Group Report: review of criteria for diagnosis of autoimmune hepatitis. J Hepatol. 1999;31:929–938.

    Article  CAS  PubMed  Google Scholar 

  21. Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ. Primary biliary cirrhosis. Hepatology. 2009;50:291–308.

    Article  PubMed  Google Scholar 

  22. Fleming ID. AJCC/TNM cancer staging, present and future. J Surg Oncol. 2001;77:233–236.

    Article  CAS  PubMed  Google Scholar 

  23. Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19:329–338.

    Article  CAS  PubMed  Google Scholar 

  24. Silva IS. Cancer Epidemiology: Principles and Methods. Geneva, Switzerland: World Health Organization; 1999.

    Google Scholar 

  25. Beasley RP, Hwang LY, Lin CC, Chien CS. Hepatocellular carcinoma and hepatitis B virus. A prospective study of 22,707 men in Taiwan. Lancet. 1981;2:1129–1133.

    Article  CAS  PubMed  Google Scholar 

  26. Beasley RP. Hepatitis B virus as the etiologic agent in hepatocellular carcinoma. Hepatology. 1982;2(Suppl):21S–26S.

    Google Scholar 

  27. Fattovich G, Giustina G, Degos F, et al. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology. 1997;112:463–472.

    Article  CAS  PubMed  Google Scholar 

  28. Niederau C, Lange S, Heintges T, et al. Prognosis of chronic hepatitis C: results of a large, prospective cohort study. Hepatology. 1998;28:1687–1695.

    Article  CAS  PubMed  Google Scholar 

  29. Degos F, Christidis C, Ganne-Carrie N, et al. Hepatitis C virus related cirrhosis: time to occurrence of hepatocellular carcinoma and death. Gut. 2000;47:131–136.

    Article  CAS  PubMed  Google Scholar 

  30. Elmberg M, Hultcrantz R, Ekbom A, et al. Cancer risk in patients with hereditary hemochromatosis and in their first-degree relatives. Gastroenterology. 2003;125:1733–1741.

    Article  PubMed  Google Scholar 

  31. Hsing AW, McLaughlin JK, Olsen JH, Mellemkjar L, Wacholder S, Fraumeni JF Jr. Cancer risk following primary hemochromatosis: a population-based cohort study in Denmark. Int J Cancer. 1995;60:160–162.

    Article  CAS  PubMed  Google Scholar 

  32. Caballeria L, Pares A, Castells A, Gines A, Bru C, Rodes J. Hepatocellular carcinoma in primary biliary cirrhosis: similar incidence to that in hepatitis C virus-related cirrhosis. Am J Gastroenterol. 2001;96:1160–1163.

    CAS  PubMed  Google Scholar 

  33. CDC. Hepatocellular carcinoma—United States, 2001–2006. MMWR. 2010;59(No. 17).

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Conflicts of interest

No conflicts of interest exist for all authors.

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Authors and Affiliations

  1. Department of Medicine, California Pacific Medical Center, 2351 Clay Street, Suite 380, San Francisco, CA, 94115, USA

    Robert J. Wong

  2. Department of Liver Disease and Transplant Hepatology, California Pacific Medical Center, San Francisco, CA, USA

    Robert Gish, Todd Frederick, Natalie Bzowej & Catherine Frenette

Authors
  1. Robert J. Wong
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  2. Robert Gish
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  3. Todd Frederick
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  4. Natalie Bzowej
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  5. Catherine Frenette
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Corresponding author

Correspondence to Robert J. Wong.

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Wong, R.J., Gish, R., Frederick, T. et al. Development of Hepatocellular Carcinoma in Autoimmune Hepatitis Patients: A Case Series. Dig Dis Sci 56, 578–585 (2011). https://doi.org/10.1007/s10620-010-1444-6

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  • DOI: https://doi.org/10.1007/s10620-010-1444-6

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