The impact of chronic alcohol consumption on hepatocellular carcinoma: Insights from a cohort study in eastern Taiwan

Hepatocellular carcinoma (HCC) is a leading cause of cancer‐related mortality worldwide, with alcohol‐related liver disease (ALD) increasingly recognized as a significant but underexplored risk factor. While chronic hepatitis B (HBV) and hepatitis C (HCV) infections remain the primary etiologies of HCC in Taiwan, the independent impact of alcohol consumption on disease progression and survival outcomes warrants further investigation. This retrospective cohort study analyzed 513 HCC patients from Taitung MacKay Memorial Hospital, a region with a high prevalence of alcohol consumption. Patients were stratified based on alcohol intake and viral hepatitis status, and survival outcomes were assessed using logistic regression and Kaplan–Meier survival analysis. The definition of long‐term moderate alcohol consumption is characterized as a daily intake exceeding one standard drink (10–15 g of alcohol) for women and two standard drinks (20–30 g of alcohol) for men, sustained for a minimum duration of 10 years. Our findings revealed that alcohol‐related HCC was associated with significantly higher total bilirubin levels (2.39 ± 3.59 mg/dL vs. 1.43 ± 1.27 mg/dL, p = .007). When analyzed as an independent factor, alcohol consumption was linked to a significantly worse prognosis at 2, 3, and 5 years (OR: 0.447, 95% CI: 0.231–0.864 at 5 years). Male patients exhibited a higher risk of HCC development and poorer long‐term survival compared to females, while older age was significantly correlated with reduced five‐year survival. Hypoalbuminemia (OR: 2.343, 95% CI: 1.422–3.861), elevated platelet count (OR: 0.996, 95% CI: 0.993–0.999), and prolonged prothrombin time (PT) (OR: 0.123, 95% CI: 0.016–0.964) were identified as significant predictors of poor survival outcomes at 2 years. Interestingly, body mass index (BMI), total bilirubin, and hemoglobin levels were not significantly associated with survival. These findings highlight the distinct clinical characteristics and poorer prognosis of alcohol‐related HCC, underscoring the need for early identification and personalized treatment strategies for high‐risk populations. Integrating albumin levels, platelet count, and PT into routine clinical assessments may enhance prognostic evaluation and inform therapeutic decision‐making in HCC management.