Hepatic and extrahepatic malignancies in autoimmune hepatitis. A long-term follow-up in 473 Swedish patients

• Published in: Journal of hepatology 2009-02, Vol.50 (2), p.388-393
• Main Authors: Werner, Mårten, Almer, Sven, Prytz, Hanne, Lindgren, Stefan, Wallerstedt, Sven, Björnsson, Einar, Bergquist, Annika, Sandberg-Gertzén, Hanna, Hultcrantz, Rolf, Sangfelt, Per, Weiland, Ola, Danielsson, Åke
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Autoimmune hepatitis; Biological and medical sciences; Carcinoma, Hepatocellular - etiology; Child; Child, Preschool; Clinical Medicine; Colonic Neoplasms - etiology; Female; Follow-Up Studies; Gastroenterologi; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Hematologic and hematopoietic diseases; Hepatitis, Autoimmune - complications; Hepatocellular carcinoma; Humans; Klinisk medicin; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Liver Neoplasms - etiology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Lymphoma; Lymphoma, Non-Hodgkin - etiology; Male; Malignancies; Medical and Health Sciences; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Middle Aged; Other diseases. Semiology; Skin Neoplasms - etiology; Tumors
• ISSN: 0168-8278; 1600-0641; 1600-0641
• DOI: 10.1016/j.jhep.2008.08.022

Background/Aims Autoimmune Hepatitis (AIH) is a liver disease which may lead to liver cirrhosis. Cirrhosis is a well-known risk factor for hepatocellular cancer. Lymphoma is a disease, where immune modulating drugs as well as the autoimmune disease itself may contribute to the elevated risk. The aim was to investigate the risks of malignancies in a large cohort of AIH patients. Methods Four hundred and seventy-three patients with AIH were matched to the Swedish national cancer register as well as to the death cause register. Results We found an overall higher risk of malignancies in the cohort of AIH patients from the date of diagnosis with a SIR of 1.51 (95% CI 1.10–2.03). SIR in the subpopulation of well defined catchment areas and complete case finding was 23.28 (95% CI 7.5–54.34) for HCC. Lymphomas were found a SIR of 13.09 (95% CI 4.22–30.56). Conclusions There was an overall increased risk of malignancies in a cohort of AIH patients, which manly was caused by hepatobiliary cancers. However, the true risk of HCC in an AIH cirrhotic cohort has yet to be investigated. A significantly higher risk of lymphomas was also found, but no clear cut association to the use of immune modulators.