The risk of liver and bile duct cancer in patients with chronic viral hepatitis, alcoholism, or cirrhosis

No prospective study has analyzed simultaneously chronic viral hepatitis an d alcoholism as risk factors for liver carcinogenesis, while taking into co nsideration the role of cirrhosis. Nor has the risk for hepatocellular carc inoma among patients with chronic viral hepatitis been prospectively evalua ted in a low-risk Western population. Last, the relationship between hepato cellular carcinoma risk factors and bile duct cancer remains to be clarifie d. We analyzed prospectively the risk for primary liver and extrahepatic bi liary tract cancer among 186,395 patients hospitalized with either chronic viral hepatitis, alcoholism, cirrhosis, or any combination of these conditi ons through linkages between national Swedish registers. Compared with the general population, the relative risk of hepatocellular carcinoma was 34.4 for chronic viral hepatitis alone, 2.4 for alcoholism alone, and 40.7 for c irrhosis alone. Among patients with combinations of these risk conditions, the relative risk of hepatocellular carcinoma was 27.3 for chronic viral he patitis and alcoholism, 118.5 for chronic viral hepatitis and cirrhosis, 22 .4 for alcoholism and cirrhosis, and 171.4 for all 3 conditions. We found l imited evidence for an excess risk of intrahepatic, but not for extrahepati c, biliary duct cancer. Cirrhosis amplifies the risk of hepatocellular carc inoma among patients with chronic viral hepatitis, but it is not a prerequi site for liver carcinogenesis. In contrast, cirrhosis may be a necessary in termediate for the development of hepatocellular carcinoma among alcoholics .