Cirrhosis is under-recognised in patients subsequently diagnosed with hepatocellular cancer
Open accessAbstract
BACKGROUND: Most clinical practice guidelines recommend screening for HCC in patients with cirrhosis. However, patients with compensated cirrhosis are often asymptomatic and may remain unrecognised for years. AIMS: To determine the extent to which cirrhosis is unrecognised in a US Veteran population with HCC, and to evaluate the association between lack of cirrhosis recognition and stage of HCC at diagnosis. METHODS: We reviewed the electronic medical records of a random sample of HCC cases diagnosed in the national Veterans Affairs system between 2005 and 2011. We conducted multivariable analyses adjusting for patients' demographics, comorbidity, aetiology of underlying disease and healthcare utilisation including HCC surveillance. RESULTS: Of 1201 patients with HCC and cirrhosis, 24.6% had unrecognised cirrhosis prior to HCC diagnosis. Older patients [>65 years, odds ratio (OR) 2.32], African Americans (OR 1.93), patients with alcoholic or NAFLD liver disease (OR 1.69 and 4.77 respectively), HIV (OR 3.02), and fewer comorbidities (Deyo 0 vs. 3, OR 2.42) had significantly higher odds of having unrecognised cirrhosis than comparison groups. Furthermore, patients with unrecognised cirrhosis were 6.5 times more likely to have advanced stage HCC at diagnosis. The effect of cirrhosis recognition on HCC stage remained significant after adjusting for pre-specified covariates (OR 3.37). CONCLUSIONS: In one quarter of patients, cirrhosis was unrecognised prior to HCC diagnosis, and this group was significantly more likely to have advanced stage HCC. These findings emphasise the importance of timely evaluation for cirrhosis in at-risk populations as a critical step to improving outcomes for patients with HCC.
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Cirrhosis in MASLD is under-recognised compared to other aetiologies, with less than one in four individuals with cirrhosis undergoing HCC surveillance.
“Cirrhosis in MASLD is under-recognised compared to other aetiologies, 248 with less than one in four individuals with cirrhosis undergoing HCC surveillance. 249”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [248]
The Discussion reports that NAFLD-related cirrhosis was more likely to go unrecognized than HCV-related cirrhosis, supporting the comparison with HCV but not necessarily with every other aetiology. The Results report surveillance-related testing in 18.5% of patients with unrecognized cirrhosis, versus 61.4% of those with recognized cirrhosis; the Discussion reports 51% for the study cohort overall. Thus, fewer than one in four does not describe all individuals with cirrhosis. Page numbers were unavailable in our copy. (LLM, conf=0.90)
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- Authors
- Walker, M., El‐Serag, H. B., Sada, Y., Mittal, S., Ying, J., Duan, Z., Richardson, P., Davila, J. A., & Kanwal, F.
- Affiliations
- Michael E. DeBakey VA Medical Center (US)
- Corresponding author
- Davila, J. A.
- Kanwal, F.
- Venue
- Alimentary Pharmacology & Therapeutics
- Publisher
- Wiley
- Published
- 2016-01-19
- Volume
- 43
- Issue
- 5
- Pages
- 621-630
- ISSN
- 0269-2813 (ISSN-L)
- 1365-2036
- PMC
- PMC4742403
- OpenAlex
- W2292458278
- Cited by
- 84
- References
- 36
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 6 · 2023: 10 · 2022: 9 · 2021: 6 · 2020: 13 · 2019: 5 · 2018: 9 · 2017: 12 · 2016: 3
- FWCI
- 6.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Alimentary Pharmacology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (R01 CA160738)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- liver cirrhosis, hepatocellular carcinoma, HCC surveillance, veterans, non-alcoholic fatty liver disease, alcoholic liver disease, HIV, comorbidities
- MeSH terms
- Adult, Age Factors, Aged, Female, Health Services, Humans, Liver Cirrhosis, Liver Diseases, Alcoholic, Liver Neoplasms, Male, Middle Aged, Socioeconomic Factors, Veterans, Comorbidity, Non-alcoholic Fatty Liver Disease
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