To the editor,
Autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and overlap syndromes are very rare causes of chronic liver diseases (CLD) in India.1 It constitutes only 3–8% of total patients with CLD in India.2 Here, we present our data on the incidence of hepatocellular carcinoma (HCC) in patients with autoimmune liver diseases (AILD) or other etiology from our institution. In this retrospective study, 3000 adult patients (aged >18 years) with CLD were included. CLD was defined by the presence of either advanced fibrosis > F2 or cirrhosis. Of the 3000 patients, 130 (4.3%) had AILD. Eighty-five (65%) patients had AIH and 35% had (45 patients) autoimmune cholestatic liver disease (Figure 1). Among autoimmune cholestatic liver disease patients, AIH-PBC was the most common (18 patients [40%]), followed by PBC (14 patients [31%]), PSC (nine patients [20%]), and AIH-PSC overlap (two patients [4.4%]). Among other 2870 patients with CLD, majority had alcohol-related liver disease (40.3% [1158])followed by metabolic dysfunction associated steatotic liver disease (26% [751]). Chronic hepatitis B, chronic hepatitis C, Budd Chiari syndrome, and Wilson disease were present in 673 (23.3%), 201 (7%), 57 (2%), and 30 (1%) patients, respectively. The median follow-up period was 52 months (interquartile range: 36–66). During this period, only one patient in the AILD group (AIH-PSC) and 88 patients in the other etiology group developed HCC (0.7% vs 3.13% P = 0.03). In the AILD group, out of the 47 patients who had baseline cirrhosis, only one developed HCC. It suggests that even after the presence of cirrhosis, cumulative incidence of HCC remains low in patients with AILD. A recent study by Colapietro et al. revealed that despite cirrhosis, the incidence of HCC in AIH is low, which is similar to our findings.3 Our data also correspond to the previous studies from India.4
Figure 1.
Spectrum of autoimmune cholestatic liver disease and cumulative incidence of hepatocellular carcinoma.
A short period of follow-up is the major limitation of our study. Also, as all patients did not have baseline triple-phase computed tomography imaging, the presence of HCC at the diagnosis of AILD could not be ruled out. A large comparative study from India is warranted to explore the exact trend. However, elevated serum immunoglobulin G-4 can be associated with adverse outcomes in patients with AILD.5
Credit authorship contribution statement
SM: Conceptualization, data collection, analysis, writing, and draft preparation.
PM and GP: Revision and editing of the draft.
UCG: Supervision.
Conflicts of interest
None of the other authors has any conflict of interest to declare concerning this paper.
Funding
None.
Financial support
No financial support was received regarding this project.
Data availability statement
Data are available on reasonable request.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data are available on reasonable request.