Differences between hepatocellular carcinoma caused by alcohol and other aetiologies

Area of Science:

• Hepatology
• Oncology
• Gastroenterology

Background:

• Alcohol-related liver disease is a major cause of hepatocellular carcinoma (HCC) globally and in Europe.
• Metabolic dysfunction-associated steatotic liver disease with increased alcohol intake (MetALD) is a newly defined phenotype reflecting epidemiological shifts.
• HCC diagnosis in MetALD patients is often delayed and missed by screening, leading to poorer health status at diagnosis.

Purpose of the Study:

• To evaluate the prognostic impact of etiology in hepatocellular carcinoma.
• To highlight the importance of early HCC detection in alcohol-related liver disease and MetALD.
• To compare treatment outcomes for HCC based on underlying liver disease etiology.

Main Methods:

• Review of epidemiological trends in liver disease and HCC.
• Analysis of diagnostic delays and patient characteristics at HCC diagnosis in alcohol-related liver disease/MetALD cohorts.
• Comparison of HCC surveillance program outcomes with virus-related HCC.

Main Results:

• Patients with alcohol-related HCC often present with advanced disease, impaired liver function, and comorbidities.
• HCC diagnosed during surveillance in alcohol-related liver disease/MetALD patients shows high rates of first-line curative treatment (56%).
• Treatment allocation and outcomes are comparable to virus-related HCC when diagnosed via surveillance.

Conclusions:

• Liver function, general condition, and tumor burden are key prognostic factors in HCC, not the etiology of cirrhosis.
• Periodic surveillance is critical for early HCC detection in patients with alcohol-related liver disease or MetALD.
• Early diagnosis via surveillance improves eligibility for curative treatments and patient prognosis.