Low risk of hepatocellular carcinoma in patients with primary sclerosing cholangitis with cirrhosis
Open accessAbstract
Background & aims Primary sclerosing cholangitis (PSC) is associated with an increased risk of hepatobiliary malignancies. However, little is known about the incidence of hepatocellular carcinoma (HCC) among patients with PSC; current recommendations on screening these patients for HCC are conflicting. We investigated the risk of HCC in patients with PSC with cirrhosis.Methods We performed a retrospective study of patients with well-defined PSC from 2 large-volume tertiary care centers in Germany; data were collected from periods of up to 33 years. Liver cirrhosis was based on histology results or the presence of ascites, esophageal varices, or transient elastography values greater than 14 kPa. Statistical analysis was performed using the Kaplan-Meier method and the Cox proportional hazard model. Data from 509 patients (67% male), with a total of 4202 patients-years, were included in the final analysis.Results We identified 119 patients with cirrhosis. During 292 patient-years, none of these patients developed HCC. Most HCCs were identified incidentally at the time of liver transplantation. We therefore reviewed data on liver explants from 140 patients who underwent transplantation; none were found to contain HCC. In contrast to the low numbers of HCCs among patients with PSC, 35 patients developed cholangiocarcinoma, 3 patients developed gallbladder cancer, and 9 patients developed colorectal cancer.Conclusions Based on a retrospective analysis of more than 500 patients with PSC, we confirm their high risk for hepatobiliary malignancies. However, the risk of HCC, even among patients with cirrhosis, seems to be low--regular HCC surveillance may not be warranted.
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The risk of HCC in people with PSC has been reported to be quite low.
“The risk of HCC in people with PSC has been reported to be quite low.7,132,133”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [132]
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- Authors
- Zenouzi, R., Weismüller, T. J., Hübener, P., Schulze, K., Bubenheim, M., Pannicke, N., Weiler–Normann, C., Lenzen, H., Manns, M. P., Lohse, A. W., & Schramm, C.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- University of Bonn (DE)
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Schramm, Christoph
- ORCID
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 12
- Issue
- 10
- Pages
- 1733-1738
- ISSN
- 1542-3565 (ISSN-L)
- OpenAlex
- W2099019491
- Cited by
- 86
- References
- 33
- Citations by year
- 2026: 4 · 2025: 12 · 2024: 2 · 2023: 2 · 2022: 6 · 2021: 9 · 2020: 6 · 2019: 12 · 2018: 6 · 2017: 10 · 2016: 5 · 2015: 9 · 2014: 3
- FWCI
- 5.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Deutsche Forschungsgemeinschaft
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
- Keywords
- primary sclerosing cholangitis, hepatocellular carcinoma, liver cirrhosis, hepatobiliary malignancies, HCC incidence, HCC surveillance, cholangiocarcinoma, gallbladder cancer, colorectal cancer, liver transplantation, liver explants
- MeSH terms
- Adolescent, Adult, Aged, Child, Child, Preschool, Female, Germany, Carcinoma, Hepatocellular, Humans, Liver Cirrhosis, Liver Neoplasms, Male, Middle Aged, Retrospective Studies, Cholangitis, Sclerosing, Incidence, Risk Assessment, Young Adult, Biostatistics, Tertiary Care Centers
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