Author information

¹Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

²Department of Internal Medicine, Chiang Mai University, Chiang Mai, Thailands.

³Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore.

⁴Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Biostatistics & Modelling Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.

⁵Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.

⁶Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore; Division of Surgical Oncology, National University Cancer Institute, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.

⁷Division of Hepatology, Department of Internal Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

⁸Liver Center, Saga University Hospital, Saga, Japan.

⁹School of Medicine, Department of Digestive Disease Information & Research, Kurume University, Fukuoka, Japan.

¹⁰Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.

¹¹Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.

¹²Graduate School of Medicine, Yokohama City University, Yokohama, Japan.

¹³Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA.

¹⁴Houston Research Institute, Houston, Texas, USA.

¹⁵NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California San Diego, California, USA.

¹⁶Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA; Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, Washington, USA.

¹⁷Yong Loo Lin School of Medicine, National University of Singapore, Singapore; School of Medicine, Department of Digestive Disease Information & Research, Kurume University, Fukuoka, Japan.

¹⁸Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore. Electronic address: daniel_huang@nus.edu.sg.

Abstract

Background and aims: Although the burden of alcohol-associated hepatocellular carcinoma (HCC) is increasing with rising alcohol consumption, clinical presentation and outcomes of alcohol-associated HCC have not been systematically assessed. We aimed to determine the prevalence, clinical characteristics, surveillance rates, treatment allocation, and outcomes of alcohol-associated HCC.

Methods: Medline and Embase were searched from inception to January 2023. Proportional data were analyzed using a generalized linear mixed model. The odds ratio (OR) or mean difference comparing alcohol-associated HCC and other causes was obtained with pairwise meta-analysis. Survival outcomes were evaluated using a pooled analysis of hazard ratios.

Results: Of 4,824 records identified, 55 articles (86,345 patients) were included. Overall, 30.4% (CI: 24.0%-37.7%) of HCC were alcohol-associated, with the highest proportion in Europe and the lowest in the Americas. People with alcohol-associated HCC were more likely male, but similar in age and comorbidities, compared to other causes. 20.8% (CI: 11.4%-34.9%) of people with alcohol-associated HCC underwent surveillance compared to 35.0%, 31.6%, and 21.4% in hepatitis B virus, hepatitis C virus, and metabolic dysfunction-associated HCC, respectively (all P<0.05). Alcohol-associated HCC had a lower likelihood of BCLC stage (0/A) (OR: 0.7, CI: 0.6-0.9; P=0.018) and curative therapy (24.5% vs 33.9%; OR 0.7, CI: 0.5-0.9; P=0.003), and higher mortality (HR: 1.3, CI: 1.1-1.5, P=0.012) when compared to other causes.

Conclusions: Alcohol-associated HCC is associated with lower surveillance rates, more advanced BCLC stage, lower likelihood of receiving curative therapy, and poorer survival. These data call for measures to reduce heavy alcohol consumption and improve strategies for effective HCC surveillance in high-risk individuals.