Liver cancer risk is increased in patients with porphyria cutanea tarda in comparison to matched control patients with chronic liver disease

University of Milan, Milano, Lombardy, Italy
Journal of Hepatology (Impact Factor: 11.34). 11/2001; 35(4):498-503. DOI: 10.1016/S0168-8278(01)00160-X
Source: PubMed


Patients with porphyria and chronic liver disease could be at high risk of developing hepatocellular carcinoma. To define the incidence of primary liver cancer and identify variables associated with the risk of cancer in patients with porphyria cutanea tarda in comparison to control patients.
Fifty-three patients with porphyria cutanea tarda were enrolled in a prospective study (median follow-up 72 +/- 54.1 months; range 12-216) and matched individually to a control case according to age (+/-5 years), sex, duration of follow up (+/- 5 years), severity of liver disease, and hepatitis C virus infection.
During follow-up hepatocellular carcinoma developed in 18 patients with porphyria and in four control patients. Incidence of primary liver cancer was 4.8 and 1.3 x 100 patients/year in the overall series of patients and of controls, respectively. The cumulative probability of being tumor free was significantly lower in porphyria cutanea tarda than in matched controls (75 vs 95%). Variables independently associated with the risk of liver cancer were the presence of porphyria and cirrhosis at enrollment (Odds ratios: 5.3, 95% CI 1.4-19.3 and 3.0, 95% CI 1.2-7.6, respectively).
Patients with porphyria are at higher risk of developing liver cancer than matched control patients.

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    • "Other hereditary liver diseases have been associated with increased risk of HCC development, such as autoimmune hepatitis (RR 23) [69], porphyria (RR 5–36) [70, 71], α1-antitrypsin deficiency (RR 5) [72], progressive familial intrahepatic cholestasis (RR 3.7) [73, 74], glycogen storage disease type 1 (von Gierke disease) (RR unk.) [75], hereditary tyrosinemia type I (RR unk.) [76–78], Wilson's disease (RR unk.) [79], Niemann-Pick disease (RR unk.) [80], Gaucher disease (RR unk.) [81], and hereditary telangieatasias (RR unk.) [82, 83], but these associations are poorly studied due to the rarity of the disease processes. "
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    ABSTRACT: Hereditary etiologies of pancreatic and hepatobiliary cancers are increasingly recognized. An estimated >10% of pancreatic and increasing number of hepatobiliary cancers are hereditary. The cumulative risk of hereditary pancreatic cancer ranges from measurable but negligible in cystic fibrosis to a sobering 70% in cases of hereditary pancreatitis. Candidates for pancreatic cancer surveillance are those with a risk pancreatic cancer estimated to be >10-fold that of the normal population. Screening for pancreatic cancer in high-risk individuals is typically performed by endoscopic ultrasound and should begin at least 10 years prior to the age of the youngest affected relative. Disease states known to be associated with increased risk of hepatocellular cancer include hereditary hemochromatosis, autoimmune hepatitis, porphyria, and α1-antitrypsin deficiency, with relative risks as high as 36-fold. Although much less is known about hereditary bile-duct cancers, Muir-Torre syndrome and bile salt export pump deficiency are diseases whose association with hereditary carcinogenesis is under investigation.
    Full-text · Article · Jun 2011 · International Journal of Surgical Oncology
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    • "A close association exists between HCC and cirrhosis, with more than 70% of HCC cases developing in cirrhotic livers, and cirrhosis is a strong predisposing factor for HCC, with OR = 27.5 [66] [67]. It is worth noting that the human monogenic disorders of AAT deficiency [15], hemochromatosis [21], porphyrias [32], and tyrosinemia type I [36], which are all associated with an increased risk of HCC, are also associated with the development of cirrhosis. Moreover, several polygenic conditions associated with an increased risk of HCC are also predisposing conditions for liver cirrhosis, such as AIH [39], diabetes mellitus (which may be the cause or the consequence of cirrhosis) [68], and NASH [54]. "
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    ABSTRACT: Hepatocellular carcinoma (HCC) is a common form of cancer that arises from hepatocytes and whose risk may be affected by several known environmental factors, including hepatitis viruses, alcohol, cigarette smoking, and others. Rare monogenic syndromes, such as alpha1-antitrypsin deficiency, glycogen storage disease type I, hemochromatosis, acute intermittent and cutanea tarda porphyria, as well as hereditary tyrosinemia type I are associated with a high risk of HCC. Several common conditions or diseases inherited as polygenic traits e.g. autoimmune hepatitis, type 2 diabetes, a family history of HCC, hypothyroidism, and non-alcoholic steatohepatitis also show an increased risk of HCC compared to the general population. Overall, the genetic susceptibility to HCC is characterized by a genetic heterogeneity; a high individual risk of HCC may thus be caused by several unlinked single gene defects, whose carriers are rare in the general population, or by more common conditions inherited by complex genetics.
    Preview · Article · Feb 2010 · Journal of Hepatology
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    • "The most common type of PCT is an acquired form, which is triggered by toxic (e.g., alcohol) and infectious (e.g., hepatitis C virus) factors or haemosiderosis [28] [31] [32], and liver cirrhosis and hepatic iron overload are common associated findings [19]. Although each of these factors is known to increase the risk of HCC as well [5] [6] [33] [34], it has been suggested that PCT per se increases this risk further [18] [22]. "
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    ABSTRACT: Hepatic porphyries have been associated with an increased risk of primary liver cancer (PLC), which on the other hand may cause an increased porphyrin production. To evaluate the role of an underlying liver disorder we analyzed porphyrins in patients with hepatocellular carcinoma (HCC) (n = 65), cholangiocellular carcinoma (n = 3), or suspected PLC, which turned out to be metastases (n = 18) or a benign disorder (n = 11). None of the patients had a family history of porphyry or clinical signs of porphyry. Increased aminolevulinic acid or porphyrin values were common not only in patients with PLC (43%) but also in metastatic (50%) and benign (64%) liver disorders. The corresponding proportion for HCC patients with liver cirrhosis (55%) was higher (P < .05) than in those without cirrhosis (17%). We conclude that symptomatic porphyries are unusual in PLC, whereas elevated urinary and/or faecal porphyrins are common, primarily reflecting a parallel liver disease and not the PLC.
    Full-text · Article · Oct 2009 · Gastroenterology Research and Practice
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