Hepatocellular carcinoma (HCC) appears to be an uncommon complication of primary sclerosing cholangitis (PSC), especially in patients without cirrhosis and those younger than 50 years, results from a large international cohort study suggests.
Reporting in Hepatology, Magnus Holmer, PhD, of the Unit of Gastroenterology and Hepatology, Karolinska Institute, Stockholm, Sweden, and fellow investigators from the International PSC Registry analyzed longitudinal data from 3,071 patients with well-characterized PSC followed at 12 European centers for more than 38,000 person-years. They had a mean age of 36.2 years at the time of PSC diagnosis and 48.7 years at the conclusion of follow-up. During a mean follow-up of 12.5 years, 39 patients (1.3%) developed HCC, corresponding to an overall incidence of 1.01 cases per 1,000 person-years. The mean time from PSC diagnosis to HCC was 16.4 years.
Cirrhosis and age emerged as the dominant determinants of risk. In multivariable Poisson regression models, cirrhosis was associated with an approximately 11-fold higher HCC risk (incidence rate ratio [IRR], 10.8), while each additional year of age conferred a 5% increase in risk. Two-thirds of patients with HCC had documented cirrhosis before cancer diagnosis, and most cases occurred in men. By contrast, HCC risk in non-cirrhotic PSC patients remained low across all age groups and both sexes.
Age-stratified analyses showed that annual HCC incidence exceeded commonly cited cost-effectiveness thresholds for surveillance only in older patients with cirrhosis. Among men with cirrhosis, the annual incidence rate reached 0.81 at age 50 and increased to 2.22 by age 70; corresponding rates in women were lower but followed a similar age-dependent pattern. In non-cirrhotic patients, annual incidence rate remained well below 0.3 even at older ages.
“Our findings indicate that HCC surveillance may be less cost-effective in young patients with PSC and cirrhosis compared to those aged 50 years or older,” the authors concluded. “Further research is needed to determine appropriate age thresholds for initiating HCC specific surveillance in patients with PSC.”
The study was funded by the Bengt Ihre Fund and the Swedish Cancer Society, Stockholm County. Several authors reported potential conflicts of interest.
Source: Hepatology