Competing risk analysis on outcome after hepatic resection of hepatocellular carcinoma in cirrhotic patients

Abstract Background & Aims: The role of hepatocellular carcinoma (HCC) surveillance is being questioned in alcoholic cirrhosis because of the relative low HCC risk. Comorbid viral hepatitis may synergistically increase the HCC risk in alcoholic cirrhosis. This study aimed to assess the risk and predictors of HCC in patients with alcoholic cirrhosis by using competing risk analysis in an area with intermediate prevalence for hepatitis B virus.Methods: A total of 965 patients with alcoholic cirrhosis were recruited at a university-affiliated hospital in Korea and randomly assigned to either the derivation (n=643) and validation (n=322) cohort. Subdistribution hazards model of Fine and Gray was used with deaths and liver transplantation treated as competing risks. Death records were confirmed from Korean government databases. A nomogram was developed to calculate the Alcohol-associated Liver Cancer Estimation (ALICE) score.Results: Markers for viral hepatitis were positive in 21.0 % and 25.8 % of patients in derivation and validation cohort, respectively. The cumulative incidence of HCC was 13.5 and 14.9 % at 10 years for derivation and validation cohort, respectively. Age, positivity for viral hepatitis markers, alpha-fetoprotein level, and platelet count were identified as independent predictors of HCC and incorporated in the ALICE score, which discriminated low, intermediate, and high risk for HCC in alcoholic cirrhosis at the cut-off of 120 and 180. Conclusions: HCC risk can be stratified by using clinical parameters including viral markers in alcoholic cirrhosis in an area where the prevalence of viral hepatitis is substantial.

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Efficacy of radiofrequency ablation of hepatocellular carcinoma prior to liver transplantation and the need for competing-risk analysis

HepatoBiliary Surgery and Nutrition ◽

10.21037/hbsn.2018.04.05 ◽

2018 ◽

Vol 7 (4) ◽

pp. 294-296 ◽

Cited By ~ 2

Author(s):

Alessandro Cucchetti ◽

Matteo Serenari

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Radiofrequency Ablation ◽

Risk Analysis ◽

Competing Risk ◽

Competing Risk Analysis

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Risk Prediction of Hepatocellular Carcinoma in Patients With Alcoholic Cirrhosis in an Area With Intermediate Prevalence for Hepatitis B Virus Infection: a Competing Risk Analysis

10.21203/rs.3.rs-856622/v1 ◽

2021 ◽

Author(s):

Kyunghan Lee ◽

Gwang Hyeon Choi ◽

Eun Sun Jang ◽

Sook-Hyang Jeong ◽

Jin-Wook Kim

Keyword(s):

Hepatocellular Carcinoma ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Risk Analysis ◽

Viral Hepatitis ◽

Validation Cohort ◽

Alcoholic Cirrhosis ◽

Competing Risk ◽

Competing Risk Analysis ◽

B Virus

Abstract Background & Aims: The role of hepatocellular carcinoma (HCC) surveillance is being questioned in alcoholic cirrhosis because of the relative low incidence of HCC. Comorbid viral hepatitis may modify the risk, and competing outcomes may influence the actual incidence of HCC in alcoholic cirrhosis. This study aimed to assess the risk and predictors of HCC in patients with alcoholic cirrhosis by using competing risk analysis in an area with intermediate prevalence for hepatitis B virus.Methods: A total of 965 patients with alcoholic cirrhosis were recruited at a university-affiliated hospital in Korea and randomly assigned to either the derivation (n=643) and validation (n=322) cohort. Subdistribution hazards model of Fine and Gray was used with deaths and liver transplantation treated as competing risks. Death records were confirmed from Korean government databases. A nomogram was developed to calculate the Alcohol-associated Liver Cancer Estimation (ALICE) score.Results: Markers for viral hepatitis were positive in 21.0 % and 25.8 % of patients in derivation and validation cohort, respectively. The cumulative incidence of HCC was 13.5 and 14.9 % at 10 years for derivation and validation cohort, respectively. Age, positivity for viral hepatitis markers, alpha-fetoprotein level, and platelet count were identified as independent predictors of HCC and incorporated in the ALICE score, which discriminated low, intermediate, and high risk for HCC in alcoholic cirrhosis at the cut-off of 120 and 180. Conclusions: ALICE score reliably stratifies HCC risk of alcoholic cirrhosis in an area where the prevalence of viral hepatitis is substantial.

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Advanced donor age does not increase risk of hepatocellular carcinoma recurrence after liver transplantation: a retrospective two‐center analysis using competing risk analysis

Transplant International ◽

10.1111/tri.13950 ◽

2021 ◽

Author(s):

C. Cusumano ◽

L. De Carlis ◽

L. Centonze ◽

R. Lesourd ◽

G.B Levi Sandri ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Risk Analysis ◽

Competing Risk ◽

Competing Risk Analysis ◽

Donor Age ◽

Increase Risk ◽

Hepatocellular Carcinoma Recurrence

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Tenofovir Is Superior to Entecavir on Tertiary Prevention for BCLC Stage 0/A Hepatocellular Carcinoma after Curative Resection

Liver Cancer ◽

10.1159/000518940 ◽

2021 ◽

pp. 1-16

Author(s):

Ming-Chao Tsai ◽

Chih-Chi Wang ◽

Wei-Chen Lee ◽

Chih-Che Lin ◽

Kuo-Chin Chang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Risk Analysis ◽

Lower Risk ◽

Late Recurrence ◽

Competing Risk ◽

Competing Risk Analysis ◽

Risk Of Death ◽

Hcc Recurrence ◽

Curative Hepatectomy

Background: It is unclear whether entecavir (ETV) and tenofovir disoproxil fumarate (TDF) have different effects on hepatocellular carcinoma (HCC) recurrence and death in patients receiving curative hepatectomy for hepatitis B virus (HBV)-related HCC. Aims: The aim of this study was to compare the long-term efficacy of ETV and TDF in HCC recurrence and overall survival (OS) of patients after curative hepatectomy. Methods: From January 2010 to December 2019, 20,572 patients with HCC who received hepatectomy were screened for study eligibility. Finally, a total of 219 consecutive patients treated with ETV (n = 146) or TDF (n = 73) after curative hepatectomy for HBV-related HCC of Barcelona Clinic Liver Cancer stage 0 or A were analyzed by propensity score matching (PSM) (2:1) analysis and competing risk analysis. HCC recurrence and OS of patients were compared between ETV and TDF groups. Result: After a median follow-up of 52.2 months, 81 patients (37.0%) had HCC recurrence, 33 (15.1%) died, and 5 (2.3%) received liver transplantation. TDF therapy was an independent protective factor for HCC recurrence compared with ETV therapy (HR, 1.687; 95% CI, 1.027–2.770, p = 0.039); however, no difference in the risk of death or liver transplantation. Results were similar in competing risk analysis. We further found that TDF therapy was significantly associated with a lower risk of late recurrence (HR, 4.705; 95% CI, 1.763–12.558, p = 0.002), but not in early recurrence. Conclusions: TDF therapy is associated with a significantly lower risk of HCC recurrence, especially of late recurrence, than ETV therapy among patients who undergo curative hepatectomy for HBV-related early-stage HCC.

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