The incidence of malignant tumors in patients with liver cirrhosis and the impact of the development of hepatocellular carcinoma on the overall survival of patients with cirrhosis

Objective. To study the incidence of malignant tumors in liver cirrhosis patients with depending on the stage of liver cirrhosis and main etiological factor, to reveal the influence of hepatocellular carcinoma development on the overall survival of liver cirrhosis patients.

Materials and methods. A prospective observational study was conducted, including 994 patients with liver cirrhosis observed in the Sverdlovsk Regional Hepatological Center in 2015-2020.

Results. Lethal outcomes were recorded in 438 patients (44.0%). Malignant tumors were detected in 125 people (12.6%). The incidence of hepatocellular carcinoma depends both on the stage of liver cirrhosis and on the etiology. The probability of hepatocellular carcinoma in patients with liver cirrhosis Child-Pugh A was 6.3% per year, B – 7.3%, C – 5.9%, in patients with cirrhosis of viral etiology – 8.4%, alcoholic etiology – 4.5%, NAFLD – 3.8%. Additional risk factors that significantly increased the incidence of hepatocellular carcinoma were the level of AFP ≥ 100 IU/ml (p < 0.0001), male gender (p < 0.001), age ≥ 65 years (p = 0.006). Overweight (p = 0.056), diabetes mellitus (p = 0.390), arterial hypertension (p = 0.506) had a statistically insignificant effect. The presence of hepatocellular carcinoma reduced life expectancy in liver cirrhosis patients (p = 0.001). The median OS for Child-Pugh A cirrhosis without hepatocellular carcinoma was not reached, and with hepatocellular carcinoma is 81.7 months (p < 0.0001). With class B cirrhosis, the median OS decreases from 65.7 to 37.4 months (p = 0.02), and with C it does not change: 22.8 and 21.0 months (p = 0.446).

Conclusion. The data confirm the advisability of screening for the early hepatocellular carcinoma detection in liver cirrhosis patients with class A and B, regardless of underlying etiology.

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