Prediction model of hepatocarcinogenesis for patients with hepatitis C virus-related cirrhosis. Validation with internal and external cohorts.
OBJECTIVE
To estimate hepatocarcinogenesis rates in patients with hepatitis C virus (HCV)-related cirrhosis, an accurate prediction table was created.


METHODS
A total of 183 patients between 1974 and 1990 were assessed for carcinogenesis rate and risk factors. Predicted carcinogenesis rates were validated using a cohort from the same hospital between 1991 and 2003 (n=302) and an external cohort from Tokyo National Hospital between 1975 and 2002 (n=205).


RESULTS
The carcinogenesis rates in the primary cohort were 28.9% at the 5th year and 54.0% at the 10th year. A proportional hazard model identified alpha-fetoprotein (>or=20 ng/ml, hazard ratio 2.30, 95% confidence interval 1.55-3.42), age (>or=55 years, 2.02, 95% CI 1.32-3.08), gender (male, 1.58, 95% CI 1.05-2.38), and platelet count (<100,000 counts/mm3, 1.54, 95% CI 1.04-2.28) as independently associated with carcinogenesis. When carcinogenesis rates were simulated in 16 conditions according to four binary variables, the 5th- and 10th-year rates varied from 9 to 64%, and 21-93%, respectively. Actual carcinogenesis rates in the internal and external validation cohorts were similar to those of the simulated curves.


CONCLUSIONS
Simulated carcinogenesis rates were applicable to patients with HCV-related cirrhosis. Since, hepatocarcinogenesis rates markedly varied among patients depending on background features, we should consider stratifying them for cancer screening and cancer prevention programs.
Ikeda
Kenji
K
Department of Gastroenterology, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Toranomon 2-2-2, Minato-ku, Tokyo 105-8470, Japan. ikedakenji@tora.email.net.jp
Arase
Yasuji
Y
Saitoh
Satoshi
S
Kobayashi
Masahiro
M
Someya
Takashi
T
Hosaka
Tetsuya
T
Akuta
Norio
N
Suzuki
Yoshiyuki
Y
Suzuki
Fumitaka
F
Sezaki
Hitomi
H
Kumada
Hiromitsu
H
Tanaka
Akihisa
A
Harada
Hideharu
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011379:Prognosis; D015203:Reproducibility of Results