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Etiology of cirrhosis is changing. We know that overall incidence of HCC (Hepatocellular carcinoma) in cirrhotic patients (Lately the terminology has changed to ACLD -that include advanced fibrosis and cirrhosis, and the spectrum between them, with an cutoff of 15KPa in Transient elastography ) is between 1-8% with an overall 5 year incidence of 15% , but this was based on classic series from the 2000s when the etiology was more skewed towards HCV/ HBV and alcohol.
The etiology of the advanced liver disease is important, as it is thought that the viral cause has a higher incidence compared to , for example, alcohol etiology or MASLD. Most recent series place the real life yearly incidence between 2-3% per year in the US, but not globally.
This evidence- NEJM study followed prospectivelly 2340 for 1-2 years with a medium follow up of 13 months, found an incidence of 5.4% . They stratified based on characteristics and created an algorithm with applicable cutoffs, assigning a maximum of six points: platelet count less than 150×109/l, LSM greater than or equal to 15 kPa, age greater than or equal to 50 years, male sex, controlled/uncontrolled viral hepatitis, or presence of steatotic liver diseases. Patients in the high-risk group (≥4 points) had an HCC incidence of 15.6% (95% confidence interval [CI], 12.1% to 18.7%) compared with the low-risk group, at 1.7% (95% CI, 0.9% to 2.5%).
Summary:
- This shows the incidence is variable and around the one described before or perhaps a bit higher (5.4% within 2 years but with a medium follow up time of of 1 year)
- The HCC risk depends on many factors, and it is higher in viral hepatitis, particularly those which are uncontrolled, male sex, age>50 yo and steatotic liver disease
- This could be of great use in the future in determining the risk tailoring to the patient specifics