Impact of alcohol consumption on treatment outcome of hepatocellular carcinoma patients with viral hepatitis who underwent transarterial chemoembolization

doi:10.4254/wjh.v14.i6.1162

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World Journal of Hepatology

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Retrospective Cohort Study

World J Hepatol. Jun 27, 2022; 14(6): 1162-1172
Published online Jun 27, 2022. doi: 10.4254/wjh.v14.i6.1162

Impact of alcohol consumption on treatment outcome of hepatocellular carcinoma patients with viral hepatitis who underwent transarterial chemoembolization

Attapon Rattanasupar, Arunchai Chang, Tanaporn Prateepchaiboon, Nuttanit Pungpipattrakul, Keerati Akarapatima, Apiradee Songjamrat, Songklod Pakdeejit, Varayu Prachayakul, Teerha Piratvisuth

Attapon Rattanasupar, Arunchai Chang, Keerati Akarapatima, Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Hatyai 90110, Songkhla, Thailand

Tanaporn Prateepchaiboon, Nuttanit Pungpipattrakul, Department of Internal Medicine, Hatyai Hospital, Hatyai 90110, Songkhla, Thailand

Apiradee Songjamrat, Songklod Pakdeejit, Division of Intervention Radiology, Department of Radiology, Hatyai Hospital, Hatyai 90110, Songkhla, Thailand

Varayu Prachayakul, Siriraj Gastrointestinal Endoscopy Center, Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkoknoi 10700, Bangkok, Thailand

Teerha Piratvisuth, NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hatyai 90110, Songkhla, Thailand

Author contributions: Rattanasupar A designed and conceptualized the study, acquired the data and drafted the manuscript; Chang A designed and conceptualized the study, acquired, analyzed, and interpreted the data, and drafted the manuscript; Prateepchaiboon T designed and conceptualized the study, acquired, analyzed, and interpreted the data; Pungpipattrakul N, Akarapatima K, Songjamrat A, and Pakdeejit S acquired, analyzed, and interpreted the data; Prachayakul V and Piratvisuth T critically revised the manuscript for important intellectual content.

Institutional review board statement: The study was reviewed and approved for publication by the Institutional Review Board of Hatyai Hospital (protocol number HYH EC 105-64-01.

Informed consent statement: The need for informed consent was waived because the de-identification of patient information before analysis.

Conflict-of-interest statement: All the authors declare that they have no conflict of interest.

Data sharing statement: No additional data are available

STROBE statement: All the authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.

Corresponding author: Arunchai Chang, MD, Assistant Professor, Doctor, Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, 182 Ruthakal road, Hatyai, Hatyai 90110, Songkhla, Thailand. busmdcu58@gmail.com

Received: February 4, 2022
Peer-review started: February 4, 2022
First decision: April 17, 2022
Revised: April 24, 2022
Accepted: June 13, 2022
Article in press: June 13, 2022
Published online: June 27, 2022
Processing time: 138 Days and 22.8 Hours

Abstract

BACKGROUND

Alcohol consumption increases the risk of hepatocellular carcinoma (HCC) in patients with pre-existing liver disease, including viral hepatitis. However, studies on the impact of alcohol consumption on the outcomes of HCC are limited. We hypothesized that alcohol had an additional effect with chronic viral hepatitis infection on treatment outcomes after transarterial chemoembolization (TACE) in patients with intermediate-stage HCC (Barcelona Clinical Liver Cancer [BCLC] -B).

AIM

To evaluate the additional effect of alcohol on treatment outcomes of TACE among HCC patients with viral hepatitis.

METHODS

This study, conducted at Hatyai Hospital in Thailand, included HCC patients over 18 years of age with chronic viral hepatitis. Records of HCC patients with viral hepatitis classified as BCLC-B who underwent TACE as the first treatment modality between 2014 and 2019 were retrospectively reviewed. Patients with chronic viral hepatitis only were categorized under group A, and those with chronic viral hepatitis and concurrent alcohol consumption were categorized under group B. Both groups were compared, and the Cox proportional-hazards model was used to identify the survival-influencing variables.

RESULTS

Of the 69 patients, 53 were categorized in group A and 16 in group B. There were no statistically significant differences in tumor characteristics between the two patient groups. However, Group A had a statistically significantly higher proportion of complete response (24.5% vs 0%, P = 0.030) and a higher median survival rate (26.2 mo vs 8.4 mo; log-rank P = 0.012) compared to group B. Factors associated with decreased survival in the proportional-hazards model included alcohol consumption (hazards ratio [HR], 2.377; 95% confidence interval [CI], 1.109-5.095; P = 0.026), presence of portal hypertension (HR, 2.578; 95%CI, 1.320–5.037; P = 0.006), largest tumor size > 5 cm (HR, 3.558; 95%CI, 1.824-6.939; P < 0.001), and serum alpha-fetoprotein level > 100 ng/mL (HR, 2.536; 95%CI, 1.377-4.670; P = 0.003).

CONCLUSION

In HCC BCLC B patients with chronic viral hepatitis, alcohol consumption is an independent risk factor for increased mortality and decreases the rate of complete response and survival after TACE.

Keywords: Alcohol misuse; Chronic viral hepatitis; Hepatocellular carcinoma; Risk factor; Survival; Transarterial chemoembolization

Core Tip: Regular alcohol consumption is associated with increased hepatocellular carcinoma (HCC) risk, particularly in patients with pre-existing chronic liver diseases, including viral hepatitis B and C infection. However, data on the impact of alcohol consumption on HCC outcomes after treatment with transarterial chemoembolization (TACE) remain limited. This study is the first to address the additional effect of alcohol on treatment outcomes of transarterial chemoembolization TACE among HCC patients with viral hepatitis.