Influence of Alcohol Consumption on Survival Outcomes of Hepatocellular Carcinoma

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Results of the prospective CHANGH study demonstrate the effect of alcohol consumption on early diagnosis, management, and overall survival for patients with hepatocellular carcinoma.
Results of the prospective CHANGH study demonstrate the effect of alcohol consumption on early diagnosis, management, and overall survival for patients with hepatocellular carcinoma.

Survival outcomes are worsened among patients with alcohol-related hepatocellular carcinoma (HCC) compared with patients with non-alcohol-related HCC, primarily due to worse liver function and tumor characteristics at diagnosis, according to a study published in Cancer.

Alcohol consumption is among the leading causes of HCC, increasing HCC risk by nearly 5 times with prolonged abuse, and is projected to become the leading cause of HCC as hepatitis B and C care improves. Recent findings have suggested that alcohol-associated HCC is diagnosed at a later stage, making early detection and effective management of great importance.

For the prospective CHANGH study, researchers identified 1207 patients with newly diagnosed HCC between 2008 and 2009 and stratified them to alcohol-related disease (Group A) or non-alcohol-related disease (Group B) in order to compare clinical features, treatments, and outcomes.

Of the 1207 patients, 894 were assessed; 582 (65.1%) and 312 (34.9%) patients were assigned to group A and group B, respectively. Analysis showed that alcohol related HCC was more likely to be identified in patients with poorer liver function and performance status, and more likely to be diffuse in presentation.

Median overall survival (OS) for patients with alcohol-related HCC was 5.7 months vs 9.7 months in patients with non-alcohol-related disease (P = .0002). Patients in group A were further divided into an abstinent and nonabstinent group; median OS was 5.8 months in alcohol abstinent groups vs 5.0 months in nonabstinent groups (P = .09).  Survival was similar in both groups across various cancer stages, however, suggesting that OS may be more dependent on liver function and tumor characteristics at time of diagnosis.

Patients with HCC detected during a cirrhosis follow-up program had an increased lead time-adjusted OS of 11.7 months vs 5.4 months for patients who had HCC detected incidentally.

The authors concluded that “to improve the prognosis of HCC in the alcoholic population, efforts should be made to improve screening for cirrhosis and HCC as well as the management of alcohol abuse. A smaller tumor burden and better liver function at diagnosis should increase rates of patients with alcohol‐related HCC amenable to curative treatment.”

Reference

Costentin CE, Mourad A, Lahmek P, et al. Hepatocellular carcinoma is diagnosed at a later stage in alcoholic patients: results of a prospective nationwide study [published online March 28, 2018]. Cancer. doi: 10.1002/cncr.31215

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