Peter Jepsen, MD, PhD; Peter Ott, MD, DMSc; Per Kragh Andersen, PhD, DMSc; Henrik Toft Sørensen, MD, PhD, DMSc; Hendrik Vilstrup, MD, DSc
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2633.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Jepsen (e-mail, mailto:firstname.lastname@example.org). Data set: The Danish National Board of Health (www.sst.dk) extracts data from Denmark's publicly available health care registries on request. The instructions given to the Board of Health to identify the nationwide cohort are available from Dr. Jepsen. Data for the Aarhus cohort are not available.
Requests for Single Reprints: Peter Jepsen, MD, PhD, Aarhus University Hospital, Department of Hepato-Gastroenterology, Nørrebrogade 44, Aarhus 8000 C, Denmark; e-mail, mailto:email@example.com.
Current Author Addresses: Drs. Jepsen, Ott, and Vilstrup: Aarhus University Hospital, Nørrebrogade 44, Aarhus 8000 C, Denmark.
Dr. Andersen: University of Copenhagen, O. Farimagsgade 5, PB 2099, Copenhagen K 1014, Denmark.
Dr. Sørensen: Aarhus University Hospital, Olof Palmes Alle 43-45, Aarhus N 8200, Denmark.
Author Contributions: Conception and design: P. Jepsen, P. Ott, H.T. Sørensen, H. Vilstrup.
Analysis and interpretation of the data: P. Jepsen, P. Ott, P.K. Andersen, H.T. Sørensen, H. Vilstrup.
Drafting of the article: P. Jepsen, H. Vilstrup.
Critical revision of the article for important intellectual content: P. Jepsen, P. Ott, P.K. Andersen, H.T. Sørensen, H. Vilstrup.
Final approval of the article: P. Jepsen, P. Ott, P.K. Andersen, H.T. Sørensen, H. Vilstrup.
Statistical expertise: P.K. Andersen.
Administrative, technical, or logistic support: P. Ott, H. Vilstrup.
Collection and assembly of data: P. Jepsen.
Jepsen P, Ott P, Andersen PK, Sørensen HT, Vilstrup H. Risk for Hepatocellular Carcinoma in Patients With Alcoholic Cirrhosis: A Danish Nationwide Cohort Study. Ann Intern Med. 2012;156:841-847. doi: 10.7326/0003-4819-156-12-201206190-00004
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Published: Ann Intern Med. 2012;156(12):841-847.
Patients with alcoholic cirrhosis are at higher risk for hepatocellular carcinoma (HCC). The role of HCC surveillance for these patients is undefined.
To provide population-based estimates of HCC incidence and comparisons of HCC-related mortality and total mortality among patients with alcoholic cirrhosis as a basis for assessing the role of HCC surveillance.
Nationwide, registry-based, historical cohort study.
All Danish citizens with a first-time hospital diagnosis of alcoholic cirrhosis from 1993 to 2005.
Hepatocellular carcinoma incidence and mortality starting 1 year after diagnosis of alcoholic cirrhosis through 2009; ratio of HCC-related mortality to total mortality.
Among 8482 patients, 169 developed HCC. A total of 5734 patients died, 151 of whom had developed HCC. Five-year cumulative HCC risk was 1.0% (95% CI, 0.8% to 1.3%), and 5-year cumulative mortality was 43.7% (CI, 42.6% to 44.7%). Only 1.8% of all deaths were HCC-related. In sensitivity analyses that included all possible HCC diagnoses and a subpopulation of patients who were followed by hepatologists, the highest 5-year HCC risk was 1.9% (CI, 0.8% to 3.9%). These patients did not have higher mortality than patients in the nationwide cohort.
Cirrhosis and HCC diagnoses were made by hospital physicians without uniform clinical criteria, and use of registry data precluded detailed information on clinical care of patients, including HCC surveillance.
Danish patients with alcoholic cirrhosis have a low risk for HCC, and HCC contributes little to their high mortality. On the basis of these data, HCC surveillance would be expected to have a minimal effect on mortality and is unlikely to be cost-effective.
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Gastroenterology/Hepatology, Gastrointestinal Cancer, Hematology/Oncology, Liver Cancer, Liver Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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