Cirrhosis Patients With Liver Nodules Have Greatly Increased Risk of Cancer

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Cirrhosis patients with small nodules in their livers are 25 times more likely to develop cancer than those without nodules, a study conducted at UNC Hospitals has concluded.

These findings have great implications for the treatment of patients with cirrhosis who are candidates for liver transplantation, said Dr. Mark W. Russo, corresponding author of the study, which is published in the March issue of the American Journal of Gastroenterology.

People with cirrhosis who are liver transplant candidates move up on the transplant priority list if they meet certain criteria for hepatocellular carcinomas, or cancerous liver tumors, said Russo, an assistant professor in the University of North Carolina at Chapel Hill School of Medicine's Division of Gastroenterology and Hepatology. Essentially, if their nodules - small growths of tissue that may or may not develop into tumors - aren't too big and there aren't too many of them, they meet the criteria.

"If the patients satisfy these criteria, they can perhaps be transplanted sooner than someone without a liver cancer," he said.

In addition, the study shows that cirrhosis patients with nodules of less than half an inch in diameter should be followed with imaging studies such as magnetic resonance imaging (MRI) more frequently than patients without nodules, Russo said.

"The critical thing with hepatocellular carcinomas is to find them when they are small and, therefore, treatable," added co-author Dr. Richard C. Semelka, professor and vice chairman for clinical research in the department of radiology.

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Hepatocellular carcinomas, or HCC, are cancerous tumors on the liver. They account for 80 percent to 90 percent of liver cancers. The occurrence of HCC nationwide has doubled during the last 20 years, and the long-term survival of patients with HCC remains poor. The major risk factor for HCC is cirrhosis, a chronic liver disease that causes damage to liver tissue. In the United States, cirrhosis is caused most often by hepatitis C infection or alcohol abuse.

Since no prior studies directly compared the risk of developing hepatocellular carcinoma in patients with liver nodules to those without, Russo and several UNC colleagues set out to do precisely that. They included in their study 310 patients who were liver transplant candidates at UNC Hospitals between 2001 and 2004. Of these, 133 received liver transplants while the study was under way. At the start of the study, none of these patients had been diagnosed with HCC.

The researchers reviewed the abdominal MRI, clinical and laboratory records of these patients. Patients without liver nodules had an abdominal MRI once a year, while those with liver nodules had an abdominal MRI every three to six months. In addition, pathologists examined livers removed from the patients who underwent liver transplant for evidence of nodules and hepatocellular carcinoma.

They found that the one-year incidence of HCC in the patients with liver nodules was 11 percent, while the rate was 0.5 percent in the patients without nodules. The adjusted risk for HCC in the group with nodules was 25 times higher than in the group without nodules. Among the patients who received liver transplants, 50 percent of those with liver nodules were found to have HCC, while only 3.6 percent of those without nodules met that diagnosis.

The study identifies a subgroup of patients with cirrhosis at a very high risk for developing HCC, the authors wrote in their conclusion. "Based on these findings, follow-up MR imaging for cirrhotic patients with liver nodules is warranted."

In addition to Russo and Semelka, the UNC co-authors were Dr. Ertan Pamuklar and radiology technician Zeynap Firat, both from the department of radiology; Dr. Richard David Gerber from the department of surgery; Tilak U. Shah, a fourth-year medical student at UNC; and Dr. Roshan Shrestha, a former professor in the Division of Gastroenterology and Hepatology (no longer at UNC).

Funding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases and UNC's Center for Gastrointestinal Biology and Diseases.

By UNC News
This page is updated on May 11, 2013.

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