title: Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Hospital Central de Asturias, Oviedo, Spain. Department of Gastroenterology, Hospital de Cabueñes, Gijón, Spain.
authors.forename: Rosario F
authors.initials: RF
authors.lastname: Velázquez
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Navascués
authors.forename: Antonio
authors.initials: A
authors.lastname: Linares
authors.forename: Ramón
authors.initials: R
authors.lastname: Pérez
authors.forename: Nieves G
authors.initials: NG
authors.lastname: Sotorríos
authors.forename: Isabel
authors.initials: I
authors.lastname: Martínez
authors.forename: Luis
authors.initials: L
authors.lastname: Rodrigo
mesh_terms: 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
chemical_list: D018937:Hepatitis C Antibodies; D000509:alpha-Fetoproteins; D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase