Incidence and predictors of non-hepatic cancers in biopsy-proven alcohol-related liver disease.
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All Authors
Brahmania, M.
Hindi, Z.
Shi, N.
Arab, JP.
Rajoriya, N.
Aithal, GP.
Allison, M.
Hagstrom, H.
Likhitsup, A.
McCune, A.
LTHT Author
Parker, Richard
LTHT Department
Abdominal Medicine & Surgery
Hepatology
Liver Unit
Hepatology
Liver Unit
Non Medic
Publication Date
2025
Item Type
Journal Article
Language
Subject
Subject Headings
Abstract
INTRODUCTION AND OBJECTIVES: Alcohol-related liver disease (ALD) is a known contributor to non-hepatic cancers (NHC). We aimed to describe the incidence and predictors of NHC in patients with ALD.
MATERIALS AND METHODS: The WALDO study is a multicenter cohort study of patients with histologically characterized ALD. Participants are followed from the time of liver biopsy and outcomes are captured from health records. The primary outcome was the incidence of the first NHC. Risk factors for NHC were presented as unadjusted and adjusted sub-distribution hazards (SDH) based on competing risk analysis. Statistical analyses were done in R.
RESULTS: 694 patients were included. The median age was 51 years (IQR 43- 59), 428 (62 %) patients were male and 349 (50 %) had cirrhosis on biopsy. During a median follow-up of 4.9 years (IQR 1.3 - 9.6 years), 78 patients (11 %) with ALD developed NHC. The cumulative incidence of NHC in ALD was 2.4 % (1.4 - 3.9 %) over five years. The most common site of NHC was respiratory (17 cases, 22 % of NHC) and digestive tract (17 cases, 22 %) and cancers of the head and neck (13 cases, 17 %). On multivariable analysis, increasing age (SDH 1.03; CI 1.00-1.07; p=0.037), previous smoking (SDH 5.11; CI 1.91-13.66; p= 0.001) and current smoking (SDH 3.84; CI 1.50-9.84; p = 0.005) along with cirrhosis (SDH 2.14; CI 1.10 -4.13; p=0.024) were associated with a higher risk of NHC.
CONCLUSIONS: NHC's are common in patients with biopsy-confirmed ArLD. Addressing risk factors for NHC's should be encouraged during routine follow-up to reduce the incidence.
Journal
Annals of Hepatology