Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis.
Better knowledge of the risk factors associated with the appearance of hepatocellular carcinoma (HCC) could improve the efficacy of surveillance programs. A total of 463 patients aged 40 to 65 years with liver cirrhosis in Child-Pugh class A or B were included in a program of early diagnosis. The predictive value of different risk factors was evaluated using the Kaplan-Meier method and Cox regression model. Thirty-eight patients developed HCC. In the multivariate analysis, 4 variables showed an independent predictive value for the development of HCC: age 55 years or older, antibody to hepatitis C virus (anti-HCV) positivity, prothrombin activity 75% or less, and platelet count less than 75 x 10(3)/mm(3). According to the contribution of each of these factors to the final model, a score ranging between 0 and 4.71 points was constructed to allow the division of patients into 2 different risk groups. The low-risk group included those with a score of 2.33 points or less (n = 270; 4 with HCC; cumulative incidence of HCC at 4 years, 2.3%), and the high-risk group included those with a score greater than 2.33 (n = 193; 34 with HCC; cumulative incidence of HCC at 4 years, 30.1%) (P =.0001). In conclusion, a simple score made up of 4 clinical and biological variables allowed us to distinguish 2 groups of cirrhotic patients at high and low risk for the development of HCC. We believe this score can be useful in establishing a subset of cirrhotic patients in whom a surveillance program for early detection of HCC could be unjustified.
Velázquez
Rosario F
RF
Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain. Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain.
Rodríguez
Manuel
M
Navascués
Carmen A
CA
Linares
Antonio
A
Pérez
Ramón
R
Sotorríos
Nieves G
NG
Martínez
Isabel
I
Rodrigo
Luis
L
D000328:Adult; D000367:Age Factors; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000453:epidemiology; D005260:Female; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies; D011517:Prothrombin Time; D012307:Risk Factors; D000509:alpha-Fetoproteins / Q000032:analysis
D018937:Hepatitis C Antibodies; D000509:alpha-Fetoproteins; D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase