Fig. 1.

Direct acyclic graph.

Both active viral replication and excessive alcohol consumption, alone or combined, may favour the development of cirrhosis. Several comorbidities (in particular, metabolic syndrome) further increase this risk and are more often associated with alcohol-related liver disease. Once cirrhosis is established, the progression towards liver failure may lead to both liver decompensation and HCC development. Such progression is dramatically decreased in HCV- or HBV-infected patients in whom sustained virosuppression can be achieved. Liver decompensation and subsequent end-stage liver disease, more frequently encountered in patients with alcohol-related cirrhosis, may act as competing risks of death, both before HCC development and following cancer management. HCC, hepatocellular carcinoma.