The clinical behavior and survival of patients with hepatocellular carcinoma and a family history of the disease.

Purpose: Familial clustering is a common feature of hepatocellular carcinoma (HCC) as well as a risk factor for the disease. We aimed to assess whether such a family history affected prognostic outcomes in patients with HCC diagnosed at different stages of the disease.

Materials/methods: This hospital registry-based cohort study included 5484 patients initially diagnosed with HCC. Individual family histories of cancer were obtained by interview and reported by trained nurses who constructed three-generation pedigrees. Overall survival data were compared between cases with and without first-degree relatives affected by HCC, with adjustment for other potential predictors.

Results: Of 5484 patients, 845 (15.4%) had first-degree relatives with a history of HCC. Family history was associated with longer survival in the entire cohort (adjusted hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.80-0.98, P = .025). A significant trend for reduced risk of death with increasing number of affected family members was also observed (P for trend = 0.018). The stage-stratified analysis showed that the presence of family history was especially associated with a reduced risk of death in the subset of patients with HCC at a (very) early stage (adjusted HR 0.83, 95% CI 0.69-0.99; P = .042). The proportion of cases receiving curative treatment was also higher in early-stage patients with a family history (72.6% vs 63.3%; P < .001).

Conclusions: A first-degree family history of the disease is a prognostic factor for improved survival in patients with HCC, especially in those whose tumors can be cured by radical treatments.