A new study indicates that patients with alcohol-related liver cancer often do not live as long as patients with liver cancer that is not associated with alcohol consumption, mainly due to diagnoses at later stages. The findings indicate that efforts should be made to improve both screening for early signs of liver cancer and the management of alcohol abuse.

To compare aspects of alcohol-related and non-alcohol–related liver cancer, Charlotte Costentin, MD, and her colleagues at Henri Mondor Hospital examined 894 patients with newly diagnosed liver cancer. The study subjects were followed for 5 years, and included 582 patients (65%) who had a history of chronic alcohol abuse and 312 (35%) who did not. Investigators also recorded whether patients with alcohol-related liver cancer were abstinent at the time of cancer diagnosis.

By the time of the investigators’ final analyses, a total of 601 patients had died. Alcohol-related liver cancers were more likely to be diffuse and were detected in patients with worse liver function. Median overall survival was 9.7 months for those in the non-alcohol–related group, versus 5.7 months for those in the alcohol-related group.

When investigators looked at each stage of cancer individually, however, survival was similar among patients with non-alcohol–related cancer and those with alcohol-related cancer. The findings suggest that patients with alcohol-related liver cancer have a reduced overall survival mainly due to worse liver function and tumor characteristics at diagnosis.

The analysis also examined whether patients were participating in cirrhosis follow-up programs before their cancers were diagnosed. Most people who develop liver cancer show signs of scarring, or cirrhosis, in the liver, and international guidelines recommend ultrasound every 6 months to detect early liver cancer in patients with cirrhosis.

Patients whose liver cancer was detected during a cirrhosis follow-up program had improved survival compared with patients whose cancer was diagnosed incidentally. This difference was especially pronounced for patients with non-alcohol–related liver disease or those with alcohol-related liver disease who were no longer drinking alcohol, when compared with non-abstinent patients. Also, non-abstinent alcoholic patients had the lowest survival in the study, even when restricting the analysis to patients involved in cirrhosis follow-up programs.

“To improve prognosis of liver cancer in the alcoholic population, efforts should be made to implement effective screening programs for both cirrhosis and liver cancer, and to improve access to alcoholism treatment services,” says Costentin. “A smaller tumor burden and a better liver function at diagnosis should translate into higher rates of patients with alcohol-related liver cancer amenable to curative treatment such as tumor resection or ablation and liver transplantation.”

REFERENCE

  1. Costentin C, MouradA, LahmekP, et al. Hepatocellular carcinoma is diagnosed at a later stage in alcoholic patients: results of a prospective nationwide study. Cancer. Published online in advance, March 28, 2018; doi: 10.1002/cncr.31215.