Wayne Kuznar, for MDLinx | April 12, 2018
Mortality from liver cirrhosis is greater than that of the five major cancers—lung, liver, stomach, colorectal, and breast cancer—reported researchers from South Korea. In addition, death from liver cirrhosis occurred at a younger age than death from cancer. Their findings, published online in Hepatology International, suggest the need to prioritize the development of appropriate health interventions for patients with liver cirrhosis.
Corresponding author Dong Joon Kim, MD, PhD, said that the greater early mortality associated with liver cirrhosis translates into a greater socioeconomic burden compared with cancer.
“This finding might help to adequately allocate health resources and the proper implementation of health policies,” said Dr. Kim, chair, Division of Gastroenterology and Hepatology, Hallym University College of Medicine, Chuncheon, South Korea.
The study, sponsored by the Korean Association for the Study of the Liver and the Korean Liver Foundation, was conducted in response to the low survival rate of patients with liver cirrhosis and the need to design improved health policy regarding this condition. Few studies have directly compared the mortality of liver cirrhosis with that of cancer or other fatal diseases, the authors noted.
For the study, researchers used health care data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database, which provided a representative sample of 1 million of the 46 million people in Korea between 2002 and 2010. The researchers compared eight-year mortality from liver cirrhosis with that of the five aforementioned cancers.
During this period, 800 of 2,609 (30.7%) patients with liver cirrhosis died, as did 1,316 of 4,852 (27.1%) patients with the five major cancers.
The researchers also calculated survival estimates, which showed that the mortality rate per 1,000 person-years was again higher for liver cirrhosis (46.9) compared with that for cancer (41.1). Among patients with liver cirrhosis, mortality rates were 43.4 and 56.5 per 1,000 person-years for compensated and decompensated liver cirrhosis, respectively.
Overall survival at 8 years was 73% for persons with cancer and 69.5% for those with liver cirrhosis (including 71.1% for those with compensated and 65.5% for those with decompensated liver cirrhosis).
“This difference in mortality was mainly due to patients with both liver cirrhosis and cancers, who were more likely to be sicker and die during the 8-year follow-up,” the investigators wrote. “It is notable, however, that mortality was still higher for liver cirrhosis patients, even when they were excluded from the analyzed sample.”
A sensitivity analysis that excluded patients with both liver cirrhosis and one of the five cancers showed that the relative mortality was still greater for liver cirrhosis (hazard ratio [HR] 1.27).
The adjusted HR for mortality was 1.47 for liver cirrhosis relative to the five cancers. When the analysis was limited to decompensated liver cirrhosis, the adjusted HR for mortality was 1.82 relative to cancer.
More males and younger patients died from liver cirrhosis than from cancers. Of the 800 deaths from liver cirrhosis, 78.13% occurred in males and 62.3% occurred in the 50- to 69-year-old age group. Of the 1,316 who died from cancer, 63.37% were male and 62.4% were in the 60- to 79-year-old age group. Nearly three fourths (70.9%) of the patients with liver cirrhosis died before age 65, whereas 54.6% of the patients with the five cancers died after age 65.
According to Dr. Kim, the socioeconomic burden of liver cirrhosis not only outweighs that of cancers, but “the socioeconomic impacts could be greater when considering that more males and younger patients are subject to death from liver cirrhosis than from cancers. This implies that we need to prioritize the development of appropriate health interventions for liver cirrhosis just as we have done for cancer.”