A prospective study on hepatocellular carcinoma in liver cirrhosis: respective roles of alcohol and hepatitis C virus infection.

To assess the interaction of alcohol and HCV infection in hepatocarcinogenesis, we prospectively studied 447 patients with liver cirrhosis (LC) who presented to our out-patient clinics in a month; 163 patients with habitual drinking (AL-LC) who had taken more than 72 g alcohol per day (HCV positive 79 cases: HCV+AL; HCV negative 84 cases: AL); 176 with HCV infection but without alcohol intake; 39 with HB infection; and 82 with liver disease from other etiologies such as primary biliary cirrhosis (PBC). In the HCV group, HCC developed in 15 patients in the first year and 10 in the second year; the cumulative appearance rate was 11% and 16%, respectively. There was no difference in the HCC appearance rate between the two groups. In the AL group, the cumulative HCC occurrence rate was only 2% in the first year, and 2% in the second year. The appearance rate was significantly lower in the AL group compared with the HCV and the HCV+AL groups. One-hundred and fourteen patients (94 with HCV, 20 with HCV+AL) who had a history of blood transfusion more than 10 years ago were selected. A year-adjusted disease occurrence rate calculated by the Kaplan-Meier method showed that the HCV+AL group had a significantly higher disease occurrence rate than the HCV group. Theses results suggest that although alcohol alone does not become an independent risk factor for HCC from LC, it may accelerate the development of HCC caused by HCV, at least in the group with a history of blood transfusion.