Alcohol intake increases the risk of hepatocellular carcinoma in patients with hepatitis C virus-related compensated cirrhosis: a prospective study.
Vandenbulcke H et al.
J Hepatol 2016 Sept ; 65(3) :543-51

Abstract:
Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear.
Aim: To determine the impact of alcohol intake and viral eradication on the risk of hepatocellular carcinoma (HCC), decompensation of cirrhosis and death.
Patients and methods: Data on alcohol intake and viral eradication were prospectively collected in 192 patients with compensated HCV-related cirrhosis.
Results: 74 patients consumed alcohol (median alcohol intake: 15 g/day); 68 reached viral eradication. During a median follow-up of 58 months, 33 patients developed HCC, 53 experienced at least one decompensation event, and 39 died. The 5-year cumulative incidence rate of HCC was 10.6% (95% CI: 4.6-16.6) in abstainers vs. 23.8% (95% CI: 13.5-34.1) in consumers (p=0.087), and 2.0% (95% CI: 0-5.8) vs. 21.7% (95% CI: 14.2-29.2) in patients with and without viral eradication (p=0.002), respectively. The lowest risk of HCC was observed for patients without alcohol intake and with viral eradication (0%) followed by patients with alcohol intake and viral eradication (6.2% [95% CI: 0-18.4]), patients without alcohol intake and no viral eradication (15.9% [95% CI: 7.1-24.7]), and patients with alcohol intake and no viral eradication (29.2% [95% CI: 16.5-41.9]) (p=0.009). In multivariate analysis, lack of viral eradication and alcohol consumption were associated with the risk of HCC (hazard ratio for alcohol consumption: 3.43, 95% CI: 1.49-7.92, p=0.004). Alcohol intake did not influence the risk of decompensation or death.
Conclusion: Light-to-moderate alcohol intake increases the risk of HCC in patients with HCV-related cirrhosis. Patient care should include measures to ensure abstinence.

Expert's Commentary

The impact of heavy alcohol intake on liver disease severity is well accepted, but the impact of light-to-moderate alcohol is less clear. This well done study assessed the impact of alcohol intake and HCV viral eradication on clinical outcomes including HCC, decompensation, and death. This study provides good insight into the role of alcohol intake on liver disease complications and how active alcohol and HCV infection are additive in the risk of development of complications. The group with the lowest risk of HCC were those without alcohol intake who achieved HCV cure, and as has been previously reported these patients are unlikely to develop HCC. Meanwhile the highest risk occurred in those patients with both types of liver injury ongoing. Also of great interest was the comparison of which injury (HCV or alcohol) in isolation is more likely to result in HCC. Patients with only alcohol use were more likely to develop HCC than those with HCV infection who don't drink ETOH. These data confirm the current clinical practice, which is to educate all patients with cirrhosis and HCV infection not to drink alcohol, even after cure.

Dr Susanna Naggie