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High risk of primary liver cancer in a cohort of 179 patients with Acute Hepatic Porphyria

  • Original Article
  • Published:
Journal of Inherited Metabolic Disease

Abstract

Background/aims

Previous studies have indicated a high risk of hepatocellular carcinoma in acute hepatic porphyrias. In this retrospective study we present the incidence of primary liver cancer and clinical characteristics in a cohort of 179 acute porphyria patients above the age of 50 years.

Methods

Twenty-three cases with primary liver cancer were found either by a surveillance program or due to clinical suspicion. Standardized rate ratio was used to estimate the relative risk of primary liver cancer after indirect standardization. Survival data were calculated using the Kaplan-Meier method.

Results

The mean age at diagnosis was 69 years. Hepatocellular carcinoma was found in 19 patients while four patients had cholangiocarcinoma or a combination of the two. Four patients had underlying cirrhosis. Mean tumour size was 4.3 cm in the surveillance group and 10.3 cm in the non-surveillance group (p = 0.01). The overall relative risk of primary liver cancer was 86 above the age of 50: 150 for women and 37 for men. Mean survival time was 5.7 years.

Conclusion

Acute hepatic porphyria carries a high risk of primary liver cancer above the age of 50 which warrants ultrasound surveillance. Sex distribution and frequency of cirrhosis differs from more common aetiologies of primary liver cancer.

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Authors and Affiliations

  1. Department of Internal Medicine, Karolinska Institutet, Stockholm South Hospital, 11883, Stockholm, Sweden

    Eliane Sardh & Dan E. H. Andersson

  2. Porphyria Centre Sweden, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Eliane Sardh & Pauline Harper

  3. Department of Gastroenterology and Hepatology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Staffan Wahlin

  4. Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Mikael Björnstedt

Authors
  1. Eliane Sardh
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  2. Staffan Wahlin
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  3. Mikael Björnstedt
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  4. Pauline Harper
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  5. Dan E. H. Andersson
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Corresponding author

Correspondence to Eliane Sardh.

Additional information

Communicated by: Robert J. Desnick

DEH Andersson, P Harper: Shared senior authorship

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Sardh, E., Wahlin, S., Björnstedt, M. et al. High risk of primary liver cancer in a cohort of 179 patients with Acute Hepatic Porphyria. J Inherit Metab Dis 36, 1063–1071 (2013). https://doi.org/10.1007/s10545-012-9576-9

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  • DOI: https://doi.org/10.1007/s10545-012-9576-9

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