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Patients with cirrhosis are at elevated risk for hepatocellular carcinoma (HCC), particularly if they have hepatitis C virus infection; the risk for HCC varies based on the underlying liver disease. Although patients with primary sclerosing cholangitis (PSC) are known to be at elevated risk for hepatobiliary cancer, specifically cholangiocarcinoma (CCA), the risk for HCC among patients with PSC and cirrhosis is unknown.
In a retrospective cohort study, investigators assessed the risk for HCC in patients with PSC from two large German referral centers. All patients had well characterized PSC. Cirrhosis was diagnosed based on biopsy or clinical, laboratory, or radiographic evidence. Imaging was performed at least annually.
The study cohort of 509 patients (men, 67%) was followed for a median of 7 years (4204 patient-years). Among the 119 patients identified with cirrhosis (contributing 292 patient-years of follow-up), none developed HCC and 47 developed hepatobiliary cancers (CCA, 35; gallbladder cancer, 3) or gastrointestinal cancers (colorectal cancer in 9 patients, all of whom had concomitant inflammatory bowel disease). Among 142 patients who underwent liver transplant, none had HCC present in the explanted liver.
Zenouzi R et al. Low risk of hepatocellular carcinoma in patients with primary sclerosing cholangitis with cirrhosis. Clin Gastroenterol Hepatol 2014 Oct; 12:1733. (http://dx.doi.org/10.1016/j.cgh.2014.02.008)
Comment
These results from a large retrospective study demonstrate that HCC is uncommon in PSC, even in those patients with cirrhosis, and less common than hepatobiliary and colorectal cancers. Taken together, the data suggest that HCC risk is so low that screening for HCC at the current interval that is used in patients with other causes of cirrhosis may not be justified. If these findings are validated, then the HCC screening interval may need to be adjusted in patients with PSC.