Characteristics and Outcomes of Hepatocellular Carcinoma in Patients with Autoimmune Hepatitis

Background: The incidence of HCC in patients with autoimmune hepatitis (AIH) is low and, due to the paucity of data in the literature, a thorough characterization of these patients is missing. Aim: To describe the main characteristics and outcome of patients with AIH and HCC. Methods: Among patients with HCC included in the Italian Liver Cancer (ITA.LI.CA) database during the period 2009-2022, we selected those with AIH, and we described their liver disease characteristics, modality of HCC diagnosis, tumor stage, treatment, and outcome. Results: Among 10,026 patients with HCC, we identified 23 patients (0.2%) with AIH (43.5% males, 69.6% aged > 65 years, 91.0% with cirrhosis). Fifteen patients (65.2%) had co-factors of liver disease [8 patients (34.8%) metabolic dysfunction-associated steatotic liver disease, 4 patients (17.4%) alcohol abuse, 3 patients (13.0%) AIH/Primary Biliary Cholangitis overlap syndrome]. Tumors diagnosed under surveillance (60.9%) were more frequently uninodular (85.7% vs 66.6%, p = 0.146) and Milan-in (85.7% vs 44.4%, p = 0.066) than those diagnosed outside surveillance. Treatment with curative intent was more frequent among patients under surveillance (78.6% vs 33.3%, p = 0.077). Median overall survival was 41.7 months and was remarkably longer in patients under surveillance than in those diagnosed outside surveillance (68.2 vs 27.4 months, p = 0.032). Conclusion: AIH accounts for a minimal fraction of patients with HCC, and in most patients, risk co-factors for HCC are present. In patients with AIH, too, surveillance is associated with better tumor stage, higher access rate to potentially curative treatments, and improved survival.