MULTICENTER STUDY ON INCIDENCE AND RISK FACTORS OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH AUTOIMMUNE HEPATITIS

초록

Background: A recent European multicenter study found a low incidence of hepatocellular carcinoma (HCC) in autoimmune hepatitis (AIH), even after cirrhosis development. We aimed to evaluate the incidence and predictors of HCC in Asian patients with AIH. Methods: We conducted a multicenter, retrospective study on adult patients diagnosed with AIH between January 2000 and January 2024 in three tertiary referral hospital (Asan Medical Center, Yonsei University Severance Hospital, and Korea University Hospital). AIH diagnosis was based on international guidelines and confirmed via the registration of rare intractable disease registry of the Korean National Health Insurance Database. Primary outcome was the incidence of HCC with a median follow-up period of 6.2 years. Cumulative incidence risk of HCC and assessment of its risk factors in AIH were estimated with competing risk analysis, regarding death and liver transplantation as competing risk for HCC. Results: Of 1,310 patients with AIH, 694 (53.0%), 402 (30.7%), and 214 (16.3%) patients were from Asan Medical Center, Yonsei University Severance hospital, and Korea University hospital, respectively. Median age was 58.0 years, and 1,118 (85.3%) patients were female. Cirrhosis at diagnosis was present in 619 (47.3%) patients. During follow-up period, 41 (3.1%) patients developed HCC with an annual incidence of 0.53/100 PYs. Cumulative incidence of HCC at 3, 5, 7, and 10 years were 1.8%, 2.9%, 4.2%, and 4.8%, respectively. Risk factors for HCC included male sex (subdistribution hazard ratio [SHR]: 2.31), age over 60 years (SHR: 3.52), cirrhosis (SHR: 3.79), and decompensated status at diagnosis (SHR: 2.39). Conclusion: In this study, HCC incidence in AIH was higher than that reported in the European study and associated with prognostic factors such as male sex, old age, cirrhosis, and decompensated status at diagnosis.