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Risk of liver and other types of cancer in patients with cirrhosis: a nationwide cohort study in Denmark.
Hepatology 1998; 28(4):921-5Hep

Abstract

Cancer risk in patients with cirrhosis could be modified by factors such as changes in hormonal levels, impaired metabolism of carcinogens, or alteration of immunological status. We investigated the risk of liver and various forms of cancer in patients with cirrhosis in a follow-up study. We identified 11,605 1-year survivors of cirrhosis from the files of the Danish National Registry of Patients (NRP) from 1977 to 1989. Occurrence of cancer through 1993 was determined by linkage to the Danish Cancer Registry. For comparison, the expected number of cancer cases was estimated from national age-, sex-, and site-specific incidence rates. Overall, 1,447 cancers were diagnosed among the study subjects, as compared with 708.1 expected, to yield a standardized incidence ratio (SIR) of 2.0 (95% CI: 1.9 to 2.2). In all diagnostic subgroups of cirrhosis, the risk of primary liver cancer, mainly hepatocellular carcinoma, was markedly elevated, with 245 observed cases and an overall 36-fold elevated risk (59.9-fold elevated for hepatocellular carcinoma and 10-fold for cholangiocarcinoma). Substantial and persistent excesses during follow-up were seen for all types of cancer associated with tobacco and alcohol habits (cancer of the lung, larynx, buccal cavity, pharynx, pancreas, urinary bladder, and kidney), while moderate excesses were seen for cancers of the colon and breast. The latter, however, were not complemented by any decrease in the risk of prostate cancer (SIR: 1.0; 95% CI: 0.7 to 1. 3). A slightly increased risk was seen for testis cancer, but disappeared after 10 years. We found evidence of an increased risk for liver and several extrahepatic cancers in patients with cirrhosis. Although part of this increase is likely attributable to alcohol and tobacco consumption, our study opens up the possibility that cirrhosis plays a role in the carcinogenesis of types of cancer other than liver cancer.

Authors+Show Affiliations

Department of Medicine V, Aarhus University Hospital, Aarhus, Denmark.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

9755226

Citation

Sorensen, H T., et al. "Risk of Liver and Other Types of Cancer in Patients With Cirrhosis: a Nationwide Cohort Study in Denmark." Hepatology (Baltimore, Md.), vol. 28, no. 4, 1998, pp. 921-5.
Sorensen HT, Friis S, Olsen JH, et al. Risk of liver and other types of cancer in patients with cirrhosis: a nationwide cohort study in Denmark. Hepatology. 1998;28(4):921-5.
Sorensen, H. T., Friis, S., Olsen, J. H., Thulstrup, A. M., Mellemkjaer, L., Linet, M., ... Olsen, J. (1998). Risk of liver and other types of cancer in patients with cirrhosis: a nationwide cohort study in Denmark. Hepatology (Baltimore, Md.), 28(4), pp. 921-5.
Sorensen HT, et al. Risk of Liver and Other Types of Cancer in Patients With Cirrhosis: a Nationwide Cohort Study in Denmark. Hepatology. 1998;28(4):921-5. PubMed PMID: 9755226.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of liver and other types of cancer in patients with cirrhosis: a nationwide cohort study in Denmark. AU - Sorensen,H T, AU - Friis,S, AU - Olsen,J H, AU - Thulstrup,A M, AU - Mellemkjaer,L, AU - Linet,M, AU - Trichopoulos,D, AU - Vilstrup,H, AU - Olsen,J, PY - 1998/10/2/pubmed PY - 1998/10/2/medline PY - 1998/10/2/entrez SP - 921 EP - 5 JF - Hepatology (Baltimore, Md.) JO - Hepatology VL - 28 IS - 4 N2 - Cancer risk in patients with cirrhosis could be modified by factors such as changes in hormonal levels, impaired metabolism of carcinogens, or alteration of immunological status. We investigated the risk of liver and various forms of cancer in patients with cirrhosis in a follow-up study. We identified 11,605 1-year survivors of cirrhosis from the files of the Danish National Registry of Patients (NRP) from 1977 to 1989. Occurrence of cancer through 1993 was determined by linkage to the Danish Cancer Registry. For comparison, the expected number of cancer cases was estimated from national age-, sex-, and site-specific incidence rates. Overall, 1,447 cancers were diagnosed among the study subjects, as compared with 708.1 expected, to yield a standardized incidence ratio (SIR) of 2.0 (95% CI: 1.9 to 2.2). In all diagnostic subgroups of cirrhosis, the risk of primary liver cancer, mainly hepatocellular carcinoma, was markedly elevated, with 245 observed cases and an overall 36-fold elevated risk (59.9-fold elevated for hepatocellular carcinoma and 10-fold for cholangiocarcinoma). Substantial and persistent excesses during follow-up were seen for all types of cancer associated with tobacco and alcohol habits (cancer of the lung, larynx, buccal cavity, pharynx, pancreas, urinary bladder, and kidney), while moderate excesses were seen for cancers of the colon and breast. The latter, however, were not complemented by any decrease in the risk of prostate cancer (SIR: 1.0; 95% CI: 0.7 to 1. 3). A slightly increased risk was seen for testis cancer, but disappeared after 10 years. We found evidence of an increased risk for liver and several extrahepatic cancers in patients with cirrhosis. Although part of this increase is likely attributable to alcohol and tobacco consumption, our study opens up the possibility that cirrhosis plays a role in the carcinogenesis of types of cancer other than liver cancer. SN - 0270-9139 UR - https://www.unboundmedicine.com/medline/citation/9755226/Risk_of_liver_and_other_types_of_cancer_in_patients_with_cirrhosis:_a_nationwide_cohort_study_in_Denmark_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0270913998003966 DB - PRIME DP - Unbound Medicine ER -