Characteristics and Outcomes of Hepatocellular Carcinoma (HCC) in Patients with Autoimmune Hepatitis (AIH): Insights from the Italian Liver Cancer (ITA.LI.CA) Database

Introduction

The incidence of HCC in patients with autoimmune hepatitis AIH patients is low (0.09% per year), with higher risk in those with additional risk factors.

Aim

To report characteristics and outcomes of patients with AIH and HCC.

Materials and Methods

We analyzed data from the ITA.LI.CA database (2009-2022) including 8,038 HCC and identified 18 patients (0.2%) with AIH and HCC. We evaluated liver disease-related characteristics, modality of HCC diagnosis, tumor stage, treatment, recurrence, overall survival (OS), and causes of death.

Results

Median age was 67.2 years, and male patients represented 50.0% of cases. Most patients had cirrhosis (90%). Two patients (11.1%) had Primary Biliary Cholangitis overlap, three (16.7%) concomitant alcohol abuse, while 4 (22.2%) and 3 (16.7%) were overweight and obese, respectively. Median MELD score was 11 (IQR 9-13). HCC diagnosis occurred primary during surveillance (55.6%). Most patients had single tumour (77.8%), median HCC diameter was 2.8cm (1.5–3.2), three patients (16.7%) had extra-hepatic spread or macro-vascular invasion, and 72.2% were Milan-in. Treatment with curative intent was performed in 11 patients (33.3% ablation, 22.2% resection, 5.5% transplantation). Trans-arterial chemoembolization was carried out in 6 patients (33.3%), and one patient (5.5%) was managed with best supportive care. Objective response was observed in 66.7% of patients, and early recurrence occurred in 2 patients (11.8%). Median OS was 41.7 months, and main causes of death were end-stage liver disease (57.1%) and HCC progression (42.9%). OS was longer in patients under surveillance than in those diagnosed incidentally or due to symptoms (27.3 vs. 62.8 months, p=0.049).

Conclusions

HCC in AIH is a rare event, occurring prevalently in older, male patients with cirrhosis, and with frequent concurrent factors for HCC occurrence. A high surveillance rate is associated with favorable staging at diagnosis, and with access to potentially curative treatments, thus resulting in improved survival.