O-15 ABSENCE OF DISEASE REMISSION AS A RISK FACTOR FOR HEPATOCELLULAR CARCINOMA IN PATIENTS WITH AUTOIMMUNE HEPATITIS

Abstract

Background and Aims: Hepatocellular carcinoma (HCC) occurrence is rare in autoimmune hepatitis (AIH) and data about its characteristics are still scarce. The aims of this study were to describe HCC prevalence and risks factors in AIH patients in a tertiary referral hospital. Methods: Retrospective cohort of AIH patients followed from 2003 to 2019. The hazard ratios (HR) and their respective 95% confidence intervals (95%CI) were estimated using simple Cox regression. A multivariate regression model was fitted using relevant covariates for HCC occurrence. Results: Among 355 AIH patients, 84.5% were female, 85% AIH-1, 65% with cirrhosis and mean age at AIH diagnosis of 27±18yr. Sixteen cases of HCC were diagnosed (4.5%), all of them in cirrhotic patients, 81.3% female, mean age of 49±20yr, 83% overweight (BMI 34±5kg/m2) and 3 with associated steatohepatitis. The pooled incidence rate for HCC was 3.2 per 100 patient-years. The pooled incidence of HCC in patients with cirrhosis at AIH diagnosis was 4.5 per 100 patient-years. The median time between AIH diagnosis and HCC was 9 years (1-42). At univariate analysis the factors associated with HCC risk were age at diagnosis of AIH (HR,1.05; 95%CI,1.02-1.08; p<0.001), platelet count <100 × 106/mm3 (HR,4.77; 95%CI, 1.73-13.17; p=0.003), presence of portal hypertension (HR,2.72; 95%CI,0.79-9.29; p=0.001), diabetes (HR,3.89; 95%CI,1.18-12.7; p=0.025) and disease remission at any time of follow up (HR,0.14; 95%CI,0.05-0.41; p<0.001). At multivariate analysis the factors associated with HCC risk were age at diagnosis (HR,1.05; 95%CI,1.027-1.083; p<0.001) and portal hypertension (HR,4.88; 95%CI,1.49-15.92; p=0.009). The occurrence of disease (AIH) remission during follow up was associated with lower risk of HCC (HR,0.128; 95%CI,0.043-0.38; p<0.001). Conclusions: The prevalence of HCC in this cohort was 4.5%. Advanced age at diagnosis, diabetes, platelet count <100 × 106/mm3, presence of portal hypertension and absence of disease remission during treatment were associated with greater risk of HCC.