In severe alcohol-related hepatitis, hepatocyte ballooning correlates with expression of p16 and components of a secretory phenotype that has been associated with cellular senescence

compared to those with nonalcohol-related HCC.The role of abstinence in this setting in unknown.We aimed to compare access to treatment and prognosis of patients with alcohol-related HCC and nonalcohol-related HCC and to evaluate the impact of abstinence.Method: All patients with HCC were retrospectively included in a single center during a 23-year period.Abstinence was defined as discontinuation of alcohol consumption at least 3 months before HCC diagnosis in patients with alcohol-related cirrhosis.Treatment by resection, ablation, and transplantation were considered curative.Multivariate Fine and Gray proportional hazards models were used to identify factors associated with 5-year overall mortality after adjustment for the lead-time bias.A logistic regression model was used to identify factors associated with access to curative treatment.Results: 200 patients were included, 114 (57%) with nonalcoholrelated HCC and 86 (43%) with alcohol-related HCC of whom 35 were abstainers and 51 were consumers.All of them had a cirrhosis.During a median follow-up of 14 months (95%CI: 11-16), 12 patients were transplanted and 156 died.At HCC diagnosis, consumers were younger as compared to abstainers and non-alcoholic patients (59 vs. 63 vs. 68 years, p = 0.001), had a worse liver function (MELD score: 11 vs. 10 vs. 8, p = 0.01, Child-Pugh score: 6 vs. 5 vs. 5, p = 0.02), were less likely to be screened for HCC (33% vs. 74% vs. 51%, p < 0.001) and had more frequently a metastatic disease (16% vs. 0% vs 6%, p = 0.02).After adjustment for the lead-time bias, the 5-year cumulative incidence rates of overall death were significantly lower in abstainers than in consumers and in non-alcoholic patients (51.5% vs. 78.4% vs. 80.5%, respectively, p = 0.04).In multivariate analyses, while abstainers were significantly associated with lower overall mortality as compared to consumers (HR: 0.47, 95% CI 0.28-0.80,p = 0.005), patients with nonalcohol-related cirrhosis and consumers had similar overall mortality (HR: 0.86, 95% CI 0.60-1.24,p = 0.4).The proportion of patients who received a curative treatment was 65% in abstainers, 44% in consumers and 57% in non-alcoholic patients ( p = 0.1).In multivariate analyses, preserved liver function (Child Avs.B/C, OR: 3.10 95% CI 1.58-6.26,p = 0.001) and adherence to a screening program (OR: 4.96, 95% CI 2.50-10.15,p < 0.001) were the only two factors associated with a better accessibility to curative treatment.Conclusion: Abstinence improves the outcome of patients with alcohol-related HCC because of better liver function, less advanced tumour disease and better adherence to screening.