b'u From Page 89Source: Epidemiologic, humanistic and economic burden of hepatocellular carcinoma in the USA: a systematic literature review;Hepatic Oncology; www.futuremedicine.com/doi/10.2217/hep-2020-0024We are seeing more and more patients who haveHCC surveillance among people with cirrhosis. The cirrhosis from nonviral etiologies, such as nonalco- authors noted that current surveillance recommen-holic fatty liver disease, Kanwal said. Most of thedations are based on older studies of patients with patientswithviralhepatitis-relatedcirrhosishaveactive hepatitis, with no direct evidence relating to receivedtreatmentandhavebeencuredoftheirnewer cohorts of cirrhosis patients, most of whom infection. The risk of HCC in these patients is lowerhave cured hepatitis infections or nonalcoholic fatty thantheriskinpatientswithcirrhosisandactiveliver disease. viral hepatitis. Still, all subgroups of patients had HCC risk that While the study did not find a significant differencewashigherthantheacceptedthresholdsforHCC in HCC risk among non-Hispanic whites, non-His- surveillancesupporting the current recommenda-panic Blacks and Hispanics, the risk of HCC was 2.2tion to continue HCC surveillance in patients with times higher in men than in women. The risk of HCCcirrhosis, Kanwal said.also increased with age. Patients over age 65 had aThe data also may be used to help inform measures 92% higher risk of HCC compared to those age 55to prevent HCC in cirrhosis patients. The research-and younger.ers observed association of smoking with increased Other factors that increased risk of HCC includedHCCrisksupportsrecentguidancethatcirrhosis smoking and overweight/obesity.However, dyslipid- patientsshouldbecounseledonabstainingfrom emia was associated with a lower risk of HCC.smoking. The study also provides evidence that obe-The risk factors for liver disease in veterans aresity is associated with increased HCC risk among now similar to the risk factors in nonveterans, saidpatients with cirrhosis, showing that the mechanisms Kanwal. Hence, there will need to be a focus onof obesity-related hepatocarcinogenesis need to be managing overweight and smoking, if we were tofurther examined. continue to bend the curve within the VA. 1Kanwal, F, Khaderi S, Singla, AG, Loo, N, Asrani, SK, et al. Risk Thestudyresultsalsocouldguidefutureanaly- factors for HCC in contemporary cohorts of patients with cirrhosis. sesoftheeffectivenessandcost-effectivenessofHepatology. Published March 1, 2022. DOI: 10.1002/hep.32434. 96'