Iván Herrera , Susana Almenara , Pablo Bellot , Cayetano Miralles , Maria Rodriguez , Lucia Gómez-González , José M. Palazón , Sonia Pascual , Pedro Zapater
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Longitudinal outcomes were assessed with multivariate Fine-Gray and Cox regression models.</p></div><div><h3>Results</h3><p>A total of 215 patients (68.4% male, median age 61 years) were included. Cirrhotic etiology was alcohol (38%), hepatitis B or C virus infection (36%), alcohol plus hepatitis B or C virus infection (9%), and other causes (17%). Sixty percent were current or former smokers. Thirty-nine cancers were observed (56% liver cancer), while 3.3 were expected (SIR 11.7; 95% confidence interval [CI] 8.6–16.1). Ten (4.6%) patients were censored for liver transplantation and 34 (15.8%) for death, constituting relevant competing risks. Smoking was significantly associated with overall cancer incidence (smokers: subdistribution hazard ratio [SHR] 3.14, 95% CI 1.33–7.38; former smokers: SHR 2.54, 95% CI 1.08–5.98). In the multivariable regression analysis, viral etiology, Child-Pugh score (B or C versus A), and smoking were associated with liver cancer, and smoking with extrahepatic cancer.</p></div><div><h3>Conclusions</h3><p>Patients with cirrhosis have an 11-fold risk of cancer compared to the general population. Risk is increased in liver and non-liver cancers. Active surveillance of any type of cancer and smoking cessation interventions are needed in these patients.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.3000,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0973688324001294/pdfft?md5=d8472df2a2b30c1d3ac7683dd8cab0f8&pid=1-s2.0-S0973688324001294-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Tobacco is a Leading Risk Factor for Liver and Extrahepatic Cancers in Patients With Liver Cirrhosis: A Prospective Cohort Study\",\"authors\":\"Iván Herrera , Susana Almenara , Pablo Bellot , Cayetano Miralles , Maria Rodriguez , Lucia Gómez-González , José M. Palazón , Sonia Pascual , Pedro Zapater\",\"doi\":\"10.1016/j.jceh.2024.101472\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background & aims</h3><p>This study aims to assess the incidence and characteristics of all cancers, hepatocellular carcinoma (HCC), and extrahepatic cancers in patients with cirrhosis of various etiologies.</p></div><div><h3>Methods</h3><p>Prospective cohort study in patients with cirrhosis but no cancer, followed every 6–9 months through the HCC early detection program. Cancer incidence was compared with Spanish population data to calculate standardized incidence ratios (SIR), and cumulative incidence was calculated separately for cancer and competing events. Longitudinal outcomes were assessed with multivariate Fine-Gray and Cox regression models.</p></div><div><h3>Results</h3><p>A total of 215 patients (68.4% male, median age 61 years) were included. 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引用次数: 0
摘要
本研究旨在评估各种病因导致的肝硬化患者中所有癌症、肝细胞癌（HCC）和肝外癌症的发病率和特征。方法对肝硬化但未患癌症的患者进行前瞻性队列研究，通过 HCC 早期检测计划每 6-9 个月随访一次。将癌症发病率与西班牙人口数据进行比较，计算标准化发病率比（SIR），并分别计算癌症和竞争事件的累积发病率。结果 共纳入 215 名患者（68.4% 为男性，中位年龄 61 岁）。肝硬化病因包括酒精（38%）、乙型或丙型肝炎病毒感染（36%）、酒精加乙型或丙型肝炎病毒感染（9%）以及其他原因（17%）。60%的人目前或曾经吸烟。观察到 39 例癌症（56% 为肝癌），预期为 3.3 例（SIR 11.7；95% 置信区间 [CI] 8.6-16.1）。10名（4.6%）患者因肝移植而剔除，34名（15.8%）患者因死亡而剔除，这构成了相关的竞争风险。吸烟与癌症总发病率有明显相关性（吸烟者：亚分布危险比 [SHR] 3.14，95% CI 1.33-7.38；既往吸烟者：SHR 2.54，95% CI 1.33-7.38）：SHR：2.54，95% CI 1.08-5.98）。在多变量回归分析中，病毒病因、Child-Pugh 评分（B 或 C 与 A）和吸烟与肝癌相关，而吸烟与肝外癌症相关。肝癌和非肝癌的风险都会增加。这些患者需要积极监测任何类型的癌症并采取戒烟干预措施。
Tobacco is a Leading Risk Factor for Liver and Extrahepatic Cancers in Patients With Liver Cirrhosis: A Prospective Cohort Study
Background & aims
This study aims to assess the incidence and characteristics of all cancers, hepatocellular carcinoma (HCC), and extrahepatic cancers in patients with cirrhosis of various etiologies.
Methods
Prospective cohort study in patients with cirrhosis but no cancer, followed every 6–9 months through the HCC early detection program. Cancer incidence was compared with Spanish population data to calculate standardized incidence ratios (SIR), and cumulative incidence was calculated separately for cancer and competing events. Longitudinal outcomes were assessed with multivariate Fine-Gray and Cox regression models.
Results
A total of 215 patients (68.4% male, median age 61 years) were included. Cirrhotic etiology was alcohol (38%), hepatitis B or C virus infection (36%), alcohol plus hepatitis B or C virus infection (9%), and other causes (17%). Sixty percent were current or former smokers. Thirty-nine cancers were observed (56% liver cancer), while 3.3 were expected (SIR 11.7; 95% confidence interval [CI] 8.6–16.1). Ten (4.6%) patients were censored for liver transplantation and 34 (15.8%) for death, constituting relevant competing risks. Smoking was significantly associated with overall cancer incidence (smokers: subdistribution hazard ratio [SHR] 3.14, 95% CI 1.33–7.38; former smokers: SHR 2.54, 95% CI 1.08–5.98). In the multivariable regression analysis, viral etiology, Child-Pugh score (B or C versus A), and smoking were associated with liver cancer, and smoking with extrahepatic cancer.
Conclusions
Patients with cirrhosis have an 11-fold risk of cancer compared to the general population. Risk is increased in liver and non-liver cancers. Active surveillance of any type of cancer and smoking cessation interventions are needed in these patients.
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