LOS ANGELES — For a patient with cirrhosis, the five-year risk of developing hepatocellular carcinoma (HCC), a highly lethal cancer with a significant increasing incidence and mortality, might be as high as 30%.
“Therefore, given the high burden of disease, early detection of HCC is critical and is associated with improved survival,” wrote researchers from the VA Greater Los Angeles Healthcare System and the David Geffen School of Medicine at UCLA. “Unfortunately, there is currently a lack of accurate and easily accessible biomarkers for the early detection of HCC.”
In an article in Digestive Diseases & Sciences, their study assesses for the first time the association between the duodenal microbiome and related metabolites in association with HCC risk in a multicenter prospective cohort of patients with cirrhosis. Researchers were able to report a novel microbial and metabolite signature that is associated with HCC risk.1
The study team recruited patients with cirrhosis without a history of HCC between May 2015 and March 2020 and prospectively followed them at three tertiary care hospitals in Los Angeles. Researchers performed microbiome analysis on duodenal biopsies and metabolomic analysis on serum samples, collected at the time of enrollment.
Ultimately, 227 participants with liver cirrhosis contributed a total of 459.58 person-years of follow-up, with 14 incident HCC diagnoses. Found to be associated with developing HCC over the follow-up period were male sex (HR = 7.06, 95% CI = 1.02-54.86) and baseline hepatic encephalopathy (HE, HR = 4.65, 95% CI = 1.60-13.52).
After adjusting for age, sex, baseline HE and alkaline phosphatase, the study team also identified an increased risk of HCC for participants with the highest vs. lowest three quartiles for duodenal Alloprevotella (HR = 3.22, 95% CI = 1.06-9.73) and serum taurocholic acid (HR = 6.87, 95% CI = 2.32-20.27), methionine (HR = 9.97, 95% CI = 3.02-32.94), and methioninesulfoxide (HR = 5.60, 95% CI = 1.84-17.10).
“Being in the highest quartile for Alloprevotella or methionine had a sensitivity and specificity for developing HCC of 85.71% and 60.56%, respectively, with an odds ratio of 10.92 (95% CI = 2.23-53.48),” the authors advised.
They suggested that “alloprevotella and methionine, methioninesulfoxide and taurocholic acid predicted future HCC development in a high-risk population of participants with liver cirrhosis.”
- Dong TS, Jacobs JP, Agopian V, Pisegna JR, et. al. Duodenal Microbiome and Serum Metabolites Predict Hepatocellular Carcinoma in a Multicenter Cohort of Patients with Cirrhosis. Dig Dis Sci. 2021 Nov 20. doi: 10.1007/s10620-021-07299-2. Epub ahead of print. PMID: 34799768.