HCC incidence rare in autoimmune hepatitis, tied to obesity, cirrhosis

The incidence of hepatocellular carcinoma (HCC) remains low in patients with autoimmune hepatitis (AIH) even after developing cirrhosis, according to a study. Factors such as obesity, cirrhosis, and AIH/primary sclerosing cholangitis (PSC) variant syndrome can increase the risk of HCC incidence.

This retrospective, observational, multicentric study was conducted on patients included in the International Autoimmune Hepatitis Group Retrospective Registry. Clinical outcomes, including HCC development, liver transplantation, and death, were evaluated.

The authors conducted Fine and Gray regression analysis, stratified by centre, to determine the effects of individual covariates. They also estimated the cumulative incidence of HCC using the competing risk method, with death as a competing risk.

This study included 1,428 patients diagnosed with AIH from 1980 to 2020 from 22 centres across Europe and Canada, with a median follow-up of 11.1 years. Of these, 293 (20.5 percent) presented with cirrhosis at diagnosis.

Twenty-four patients (1.7 percent) developed HCC during follow-up, with an incidence rate of 1.44 cases per 1,000 patient-years. The cumulative HCC incidence increased over time: 0.6 percent at 5 years, 0.9 percent at 10 years, 2.7 percent at 20 years, and 6.6 percent at 30 years of follow-up. Those who developed cirrhosis during follow-up were at greater risk of developing HCC.

The cumulative incidence of HCC was 2.6 percent at 5 years, 4.6 percent at 10 years, 5.6 percent at 15 years, and 6.6 percent at 20 years after developing cirrhosis.

Additionally, obesity (hazard ratio [HR], 2.94; p=0.04), cirrhosis (HR, 3.17; p=0.01), and AIH/PSC variant syndrome (HR, 5.18; p=0.007) at baseline were independently associated with HCC development.