Current Trends and Characteristics of Hepatocellular Carcinoma in Patients with Autoimmune Liver Diseases

Abstract

Simple Summary While hepatocellular carcinoma (HCC) is inextricably linked to underlying cirrhosis due to chronic viral hepatitis, alcohol consumption, and non-alcoholic fatty liver disease, the role of autoimmune liver diseases (AILDs) as risk factor has been disputed. In this review we present data showing AILDs to confer increased risk for HCC development, albeit lower than other hepatic diseases. We also highlight several risk factors that indicate patients with autoimmune hepatitis and primary biliary cholangitis at high and moderate risk for HCC development, including cirrhosis, older age, male sex, and co-existing factors, such as alcohol consumption and treatment response. As surveillance is of utmost importance for early diagnosis and subsequent effective treatment, we suggest refinement of screening strategies according to prevailing risk factors in patients with AILDs. Abstract Hepatocellular carcinoma (HCC), the commonest among liver cancers, is one of the leading causes of mortality among malignancies worldwide. Several reports demonstrate autoimmune liver diseases (AILDs), including autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) to confer increased risk of hepatobiliary malignancies, albeit at lower frequencies compared to other liver diseases. Several parameters have been recognized as risk factors for HCC development in AIH and PBC, including demographics such as older age and male sex, clinical features, the most decisive being cirrhosis and other co-existing factors, such as alcohol consumption. Moreover, biochemical activity and treatment response have been increasingly recognized as prognostic factors for HCC development in AIH and PBC. As available treatment modalities are effective only when HCC diagnosis is established early, surveillance has been proven essential for HCC prognosis. Considering that the risk for HCC is not uniform between and within disease groups, refinement of screening strategies according to prevailing demographic, clinical, and molecular risk factors is mandated in AILDs patients, as personalized HCC risk prediction will offer significant advantage in patients at high and/or medium risk. Furthermore, future investigations should draw attention to whether modification of immunosuppression could benefit AIH patients after HCC diagnosis.