Risk Factors for Hepatocellular Carcinoma in Patients with Cirrhosis

Recent research suggests an increase in the incidence of hepatocellular carcinoma (HCC) in the United States, which may be related to an upsurge in the sequelae of chronic liver disease from hepatitis C virus. In addition to factors related to the underlying etiology of liver disease, a number of host factors such as age, gender, and ethnic background may be associated with this increased risk. The aim of this study was to evaluate a number of potential risk factors for HCC in patients with cirrhosis. Patients with biopsy proven HCC were identified from our pathology and cancer registry databases. All those without histologic or clinical cirrhosis and non-HCC hepatic malignancies were excluded. Cirrhotic patients without HCC were also selected from the Cleveland Clinic unified transplant database and were designated controls. Extensive clinicodemographic data were obtained from the databases and chart reviews. When available, paraffin-embedded liver biopsy blocks were obtained for HFE gene analysis. Univariate comparisons were made with chi-square and Fisher's exact test and multivariate analysis was carried out with logistic regression. A total of 760 patients were included in this study, 244 documented cases of HCC and 516 cirrhotic controls without HCC. Patients' age (RR = 3.1 [2.6–3.8]; P<0.0001), male gender (RR =3.4 [2.3–5.1]; P<0.0001), African-American ethnicity (RR=3.1 [1.6–5.8]; P=0.0005), and other non-Caucasian ethnicity (RR=6.9 [3.2–14.4]; P<0.0001) were independently associated with HCC. Restricting the analysis to HCV-related cirrhosis, the same risk factors remained independently associated with HCC: age (decade; RR=2.3 [1.6–3.4]; P<0.0001), male gender (RR=2.9 [1.2–7.0]; P=0.02), African-American ethnicity (RR=3.1 [1.3–7.4]; P=0.009), and other non-Caucasian ethnicity (RR=15.8 [1.9–134]; P=0.01). Iron studies did not reveal an increased risk for iron overload or HFE mutation. Male gender, advancing age, and non-Caucasian ethnic background are independently associated with HCC.