Liver Cancer Three Times More Likely in Hepatitis-Cirrhotic Patients with High Enzyme Levels
August 13, 1999
CANCER/MedscapeWire
------------------------------------------------------------------------
Japanese researchers show a strong connection between high levels of serum alanine aminotransferase (ALT) and liver cancer among patients with hepatitis-C virus infections and associated cirrhosis (severe scarring of the liver) according to a study published in the August 15 issue of CANCER. ALT is an enzyme associated with liver damage and inflammation. Their findings indicate that patients with high ALT levels usually develop liver cancer within five years - two times faster than their low ALT level counterparts. In addition, the study suggests that suppressing necrosis (liver cell death) delays the onset of liver cancer in these patients.

Approximately 30 million people worldwide have cirrhosis associated with hepatitis-C viral infections. There is a high risk of liver cancer among these patients, but no effective treatment is currently available to prevent the development of the disease.

"Because liver cancer develops rapidly among hepatitis-C cirrhotic patients with liver cirrhosis and high levels of ALT, these patient must be closely monitored for liver cancer by ultrasound or MRI," suggests Kazuo Tarao, M.D., of the Kanagawa Cancer Center Hospital in Yokohama, Japan. "Those patients also should be treated with anti-inflammatory drugs to delay or prevent liver cancer."

Sixty-nine consecutive patients with biopsy-proven hepatitis-C and cirrhosis who had been followed for at least 5 years for the development of liver cancer were studied. Twenty-eight patients had persistently high ALT levels (greater than 80 IU) upon annual examination. Another 28 had persistently low ALT levels (less than 80 IU) upon annual exam. Thirteen patients were not included in the former two groups because of their inconstant ALR levels.

Of the 28 patients with high ALT levels, 71% developed liver cancer during an average observation period of approximately 7 years. Only 25% of patients with persistently low ALT levels, 3 times less than the high ALT group, developed liver cancer within approximately 9 years. Within 5 years of diagnosis, 54% of the high ALT group had developed liver cancer, while only 7% of the low ALT group had developed the disease.

According to the American Cancer Society, liver cancer is fairly rare in the United States and Europe, except in Italy and Spain. It is far more common in certain African and east Asian countries. In some areas, it is the most common type of cancer. For reasons not yet known, it is becoming even more common in those countries and less common in the United States and Europe. In the United States, liver cancer is about twice as common in men as in women; there are about 13,600 new cases of  liver cancer in the United States each year.