Tahir Alper CİNLİ, Sezgin VATANSEVER
İstanbul Medical Journal - 2026;27(3):238-244
Introduction: This study aimed to retrospectively compare the incidence of hepatocellular carcinoma (HCC), overall survival (OS), and HCC-free survival among patients with cirrhosis of different etiologies: alcohol-related, hepatitis B virus (HBV)-related, and combined HBV-alcohol-related. Additionally, the relationship between HBV viral load and HCC-free survival was evaluated in HBV-positive patients. Methods: This retrospective single-center cohort study included 648 patients with cirrhosis followed for more than 6 months between July 2007 and April 2014. The patients were categorized into three etiological groups: alcohol-related cirrhosis (n=310), HBV-related cirrhosis (n=294), and HBV-alcohol-related cirrhosis (n=44). Clinical characteristics, HCC incidence, overall survival, and HCC-free survival were compared across these groups. Results: During the follow-up period, HCC developed in 138 (21.3%) of the 648 patients. The prevalence of HCC differed significantly among the groups: 5.5% in the alcohol group, 34.7% in the HBV group, and 43.2% in the combined HBV-alcohol group (p<0.001). The 5-year cumulative HCC risk was 7% for the alcohol group, 40% for the HBV group, and 49% for the HBV-alcohol group. Despite these striking differences in HCC incidence, overall survival did not differ significantly among the etiological groups (p=0.367). Furthermore, in HBV-positive patients, baseline HBV DNA viral load (<106 vs. >=106 copies/mL) did not show a statistically significant difference in HCC-free survival (p=0.408). Conclusion: HBV infection, particularly when combined with heavy alcohol use, significantly and synergistically increases the risk of HCC in patients with liver cirrhosis. The exceptionally high cumulative HCC incidence in the combined HBV-alcohol group, with 40% of patients developing HCC within the first year, underscores the critical need for close surveillance in this high-risk subgroup. Despite the differing HCC rates, overall survival remains similar across the groups, reflecting the complex and multifactorial determinants of cirrhosis-related mortality.
