Could arthritis help flag future liver cancer risk in people with HFE hemochromatosis?

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HFE hemochromatosis (HH) may cause arthritis, cirrhosis, and hepatocellular carcinoma (HCC). Cirrhosis is the main risk factor for HCC in HH. Arthritis is common in HH, strongly associated with cirrhosis, and readily diagnosed. The researchers therefore evaluated whether arthritis could be clinically useful in predicting future HCC risk in HH.

This single-center observational cohort study recruited 204 clinically well-characterized patients with HH between 1974 and 2013. They attended regular follow-up for a median of 15.2 years. Clinical and biochemical information and cirrhosis status were recorded at diagnosis. HCC occurrence was defined by a documented diagnosis in the medical record.

During follow-up, 10 of the 204 patients developed HCC; 9 of these had recorded arthritis status. Among patients with arthritis at HH diagnosis, 7 of 88 subsequently developed HCC, compared with 2 of 115 without arthritis (relative risk 4.57, 95% confidence interval [CI] 1.11–19.07, P = .042).

For arthritis as a predictor of future HCC, sensitivity was 78% (95% CI 45%–96%), specificity was 58% (95% CI 51%–64%), positive predictive value was 8% (95% CI 4%–15%), and negative predictive value was 98% (95% CI 93%–100%).

Among patients who had both arthritis and cirrhosis at diagnosis, those who subsequently developed HCC had significantly higher baseline alcohol consumption than those who did not develop HCC: a median of 100 g/day versus 45 g/day (P = .0312).

The authors concluded that arthritis combined with higher alcohol consumption at HH diagnosis is associated with an increased risk of subsequently developing HCC.