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High alcohol consumption increases risk for HCC in fatty liver disease

Researchers in Japan found that high consumption of alcohol increased the risk for hepatocellular carcinoma among patients with fatty liver disease, according to data from a retrospective cohort study.

“There is one major problem with the definition of NAFLD [and it] is that generally NAFLD or alcoholic fatty liver disease in patients with fatty liver disease is defined according to the degree of their current alcohol consumption,” Yusuke Kawamura, MD, of the department of hepatology at Toranomon Hospital, Tokyo, told Healio.com/Hepatology. “There is also no information on the influence of intermediate ethanol consumption on the incidence of HCC. Therefore, in order to understand the pathophysiology of this disease, it is necessary to determine the influence of alcohol consumption on hepatocarcinogenesis from [fatty liver disease].”

Yusuke Kawamura

Patients with fatty liver disease (n = 9,959) without viral hepatitis diagnosed at Toranomon Hospital between January 1997 and December 2011 were divided into four categories based on their alcohol consumption: less than 20 g daily (n = 6,671), between 20 and 39 g daily (n = 753), between 40 and 69 g daily (n = 1,589) and more than 70 g daily (n = 946).

Researchers used Kaplan-Meier and Cox proportional hazard analysis to determine the onset of HCC over a median follow-up of 5.4 years.

Overall, 0.49% of patients developed HCC during follow-up. The yearly incidence rate of HCC was 0.05% in patients with a daily alcohol consumption of less than 20 g daily, and the cumulative incidence of HCC was different between levels of alcohol consumption (P < .001), according to the research.

Increasing levels of alcohol consumption were associated with increased yearly incidence rates for HCC: 0.06% for patients consuming 20 g to 39 g per day (HR = 1.54; 95% CI, 0.34-7.04), 0.16% for patients consuming 40 g to 69 g per day (HR = 3.49; 95% CI, 1.5-8.12) and 0.22% for patients drinking more than 70 g per day (HR = 10.58; 95% CI, 5.06-22.13), compared with patients who consumed less than 20 g alcohol daily.

Multivariate analysis showed that consuming 40 g to 69 g of alcohol daily was an independent risk factor for HCC (HR = 2.48; 95% CI, 1.01-6.05) and consuming more than 70 g per day further increased risk (HR = 12.61; 95% CI, 5.68-28).

“On the basis of these results, we recommend careful monitoring and follow-up of elderly patients with FLD and high serum [aspartate aminotransferase} and low albumin levels, thrombocytopenia, diabetes and a history of high-intermediate to excessive ethanol consumption,” the researchers concluded. “Such monitoring will lead to early diagnosis and initiation of treatment of HCC.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.