The risk of hepatocellular carcinoma in cirrhotic patients with small liver nodules on MRI.
OBJECTIVE
The presence of hepatocellular carcinoma (HCC) has important implications for patients with cirrhosis. Studies have not compared the risk of cancer in cirrhotic patients with small liver nodules to cirrhotic patients without nodules. Our aim was to determine the risk of HCC in cirrhotic patients with small liver nodules on MRI compared to those without nodules.


METHODS
We conducted a prospective study to determine the rate of HCC in cirrhotic patients with and without liver nodules. Cases were patients with liver nodule(s) less than 2 cm on MRI and controls were cirrhotic patients without nodules. Kaplan-Meier estimates and multivariate analysis were performed to estimate the risk of HCC in the two groups.


RESULTS
A total of 310 liver transplant candidates with a mean follow-up of 663 days were included in the study and 133 underwent liver transplant during follow-up. The 1-yr incidence of HCC in the liver nodule group and control group was 11% and 0.5%, respectively, p < 0.001. The adjusted risk for HCC in the liver nodule group was 25 times higher compared to the control group, HR = 25.1 [95% CI 8.0, 78.9]. In 133 candidates who underwent transplant with and without liver nodules the rate of HCC was 11 (50%) and 4 (3.6%), respectively, p < 0.001.


CONCLUSIONS
The incidence of HCC in patients with small liver nodules is significantly higher compared to patients with cirrhosis without liver nodules. The presence of small liver nodules warrants increased imaging surveillance for HCC.
Division of Gastroenterology and Hepatology and Center for Gastroenterology Biology and Disease, University of North Carolina, Chapel Hill, NC 27599-7080, USA.
Tilak U
TU
Shah
Richard C
RC
Semelka
Ertan
E
Pamuklar
Zeynep
Z
Firat
Richard D
RD
Gerber
Roshan
R
Shrestha
Mark W
MW
Russo
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D016031:Liver Transplantation / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D011446:Prospective Studies; D012306:Risk