Hepatocellular Carcinoma Incidence in Alcohol-Associated Cirrhosis: Systematic Review and Meta-analysis

Clin Gastroenterol Hepatol. 2023 May;21(5):1169-1177. doi: 10.1016/j.cgh.2022.06.032. Epub 2022 Aug 5.


Background & aims: Alcohol is one of the leading causes of hepatocellular carcinoma (HCC). However, pooled estimates of HCC incidence in alcohol-associated cirrhosis have not been evaluated systematically. We performed a pooled analysis of time-to-event data to provide robust estimates for the incidence of HCC in alcohol-associated cirrhosis.

Methods: Medline, Embase, Cochrane Central Register, Scopus, and Web of Science were searched from inception to August 2021. Individual patient data were reconstructed from published Kaplan-Meier curves, and a pooled analysis of cumulative HCC incidence was performed using a random-effects model.

Results: We screened 5022 articles and included 18 studies (148,333 patients). In the pooled analysis, the cumulative incidence of HCC in alcohol-associated cirrhosis at 1, 5, and 10 years among studies that accounted for the competing risk of death without HCC was 1%, 3%, and 9%, respectively. A secondary analysis by traditional meta-analysis determined that the HCC incidence rate was higher in cohorts enrolled in a HCC surveillance program (18.6 vs 4.8 per 1000 person-years; P = .001) vs those who were not enrolled in a surveillance program. Meta-regression showed that diabetes, smoking, variceal bleeding, and hepatic decompensation were associated with a higher risk of HCC.

Conclusions: Our analysis determined that the 5- and 10- year cumulative risk of HCC in alcohol-associated cirrhosis was 3% and 9%, respectively, with a higher incidence in cohorts that were enrolled in a HCC surveillance program. These data should be validated further in large prospective studies, and may have important implications for HCC screening and surveillance among patients with alcohol-associated cirrhosis.

Keywords: Alcohol; Cirrhosis; Hepatocellular Carcinoma; Incidence.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Carcinoma, Hepatocellular* / diagnosis
  • Carcinoma, Hepatocellular* / epidemiology
  • Carcinoma, Hepatocellular* / etiology
  • Esophageal and Gastric Varices* / complications
  • Gastrointestinal Hemorrhage / complications
  • Humans
  • Incidence
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / epidemiology
  • Liver Cirrhosis, Alcoholic / complications
  • Liver Cirrhosis, Alcoholic / epidemiology
  • Liver Neoplasms* / diagnosis
  • Liver Neoplasms* / epidemiology
  • Liver Neoplasms* / etiology
  • Prospective Studies
  • Risk Factors