INTRODUCTION Patients with alcohol-related cirrhosis (ALD cirrhosis) have an increased risk of primary liver cancer (hepatocellular carcinoma [HCC] or intrahepatic cholangiocarcinoma [iCCA]). England recommends surveillance for HCC in these patients, while Denmark does not. METHODS We performed an observational cohort study using the English Clinical Practice Research Datalink and the nationwide Danish healthcare registries to identify 17,110 English (2000-2016) and 22,122 Danish (1994-2022) patients with diagnosis codes of ALD cirrhosis. We computed and compared incidence rates and cumulative incidence of primary liver cancer, annual ultrasound scan rates, and mortality following diagnosis of primary liver cancer. RESULTS The overall risk of primary liver cancer was similar in England and Denmark: 5-year risk was 2.24% (95% confidence interval 2.00-2.49) in England (iCCA 0.07%, HCC 2.16%) and 2.36% (2.15-2.57) in Denmark (iCCA 0.05%, HCC 2.30%). The annual rate of ultrasound scans per person was 0.65 (0.63-0.67) in England and 0.44 (0.42-0.46) in Denmark. The 1-year mortality after a diagnosis of primary liver cancer was 59.2% (54.4-64.0) in England and 60.9% (57.4-64.4) in Denmark. The 3-year risks of HCC in those on vs off surveillance in England were 2.3% (1.0-4.6) vs 1.5% (1.0-2.2). DISCUSSION The risk of primary liver cancer was the same in English and Danish patients with ALD cirrhosis, and HCCs constituted 97% of primary liver cancers. Mortality with primary liver cancer was equally high in both countries. Notably, in England, where guidance recommends biannual HCC surveillance with ultrasound, patients with ALD cirrhosis were undergoing fewer than 1 ultrasound scan per year.

中文翻译：

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英格兰和丹麦酒精相关性肝硬化患者的原发性肝癌风险和死亡率：观察性队列研究。


引言 酒精相关性肝硬化 （ALD cirrhosis） 患者患原发性肝癌 （肝细胞癌 [HCC] 或肝内胆管癌 [iCCA]）的风险增加。英格兰建议对这些患者进行 HCC 监测，而丹麦则不建议。方法 我们使用英国临床实践研究数据链和丹麦全国医疗保健登记处进行了一项观察性队列研究，以确定 17,110 名英国 （2000-2016） 和 22,122 名丹麦 （1994-2022） 诊断代码为 ALD 肝硬化的患者。我们计算并比较了原发性肝癌的发病率和累积发病率、年度超声扫描率和诊断为原发性肝癌后的死亡率。结果英格兰和丹麦原发性肝癌的总体风险相似：英格兰 （iCCA 0.07%， HCC 2.16%） 的 5 年风险为 2.24% （95% 置信区间 2.00-2.49），丹麦为 2.36% （2.15-2.57） （iCCA 0.05%， HCC 2.30%）。英格兰每人的年超声扫描率为 0.65 （0.63-0.67），丹麦为 0.44 （0.42-0.46）。英格兰诊断为原发性肝癌后 1 年死亡率为 59.2% （54.4-64.0），丹麦为 60.9% （57.4-64.4）。在英格兰，接受与不进行监测的人患 HCC 的 3 年风险为 2.3% （1.0-4.6） 对 1.5% （1.0-2.2）。讨论 英国和丹麦的 ALD 肝硬化患者患原发性肝癌的风险相同，HCC 占原发性肝癌的 97%。这两个国家的原发性肝癌死亡率相同。值得注意的是，在英格兰，指南建议每年两次使用超声监测 HCC，ALD 肝硬化患者每年接受的超声扫描少于 1 次。