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Risk factors for cancer in patients with primary biliary cholangitis and autoimmune hepatitis and primary biliary cholangitis overlap syndrome.

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Author information

Affiliations

  • 1. Departamento de Gastroenterologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
      Authors
    • Braga MH 1
    • Guedes LV 1
    • Pessoa MG 1
    • Chagas AL 1
    • Terrabuio DRB 1
    • Cançado ELR 1
    (6 authors)
  • 2. Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Hospital da Polícia Militar de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
      Authors
    • Cançado GGL 2
    (1 author)
  • 3. Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil; Hospital Português, Salvador, Bahia, Brazil.
      Authors
    • Bittencourt PL 3
    (1 author)
  • 4. Instituto Alfa de Gastroenterologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
      Authors
    • Couto CA 4
    • Lima AMC 4
    • Nardelli MJ 4
    • Faria LC 4
    • Filho JG 4
    (5 authors)
  • 5. Disciplina de Gastroenterologia, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil.
      Authors
    • Ferraz MLG 5
    • Gomes NMF 5
    (2 authors)
    • Show all (17)

ORCIDs linked to this article

Annals of Hepatology, 23 Apr 2023, 28(4):101105
https://doi.org/10.1016/j.aohep.2023.101105 PMID: 37088418 

Abstract 

Introduction and objectives

Primary biliary cholangitis (PBC) and autoimmune hepatitis (AIH) and PBC overlap syndrome (AIH/PBC) have been associated with a higher risk of hepatocellular carcinoma (HCC) and extra-hepatic malignancy (EHM). This study aims to assess potential risk factors associated with cancer development in PBC and AIH/PBC.

Materials and methods

The Brazilian Cholestasis Study Group database was reviewed to compare clinical and laboratory features of PBC patients with HCC and EHM with those without cancer.

Results

Among the 752 PBC patients enrolled, 64 of them with AIH/PBC, 87 cancers were identified in 72 patients, including 20 cases of HCC and 67 of EHM. Patients with HCC had a higher prevalence of cirrhosis (95% vs. 32.5% of those subjects without cancer, p≤0.001), smoking (55% vs. 12.3%, p≤0.001), CREST syndrome (30% vs 7.6%, p=0.003) and prior azathioprine (30% vs 8%, p= 0.005) and prednisone (35% vs 14%, p= 0.018) use, whereas patients with EHM had a higher prevalence of smoking (42.3% vs 12.4% of those subjects without cancer, p= <0.001), AMA positivity (96.6% vs 80.1%, p≤0.001), azathioprine therapy (21% vs 7.9%, p= 0.01) and concurrent other autoimmune diseases. In multivariate analysis, cirrhosis, obesity and prior azathioprine therapy were independent risk factors for HCC, while Sjogren syndrome and psoriasis were associated with EHM. Fibrates reduced EHM risk.

Conclusions

The prevalence of EHM is higher when compared to HCC in PBC patients. Cirrhosis, obesity, prior azathioprine use, and concurrent autoimmune diseases were significantly associated with cancer in PBC.

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Read article at publisher's site: https://doi.org/10.1016/j.aohep.2023.101105

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