A statistical model predicting high hepatocyte proliferation index and the risk of developing hepatocellular carcinoma in patients with hepatitis C virus-related cirrhosis.
BACKGROUND
Incidence of hepatocellular carcinoma in hepatitis C virus-related cirrhosis is 4% per year. Although cost-effective, current screening could be improved.


OBJECTIVE
To develop a statistical model including non-invasive parameters able to identify patients at high risk of developing hepatocellular carcinoma.


METHODS
One hundred and fifty-eight patients (73F:85M) with compensated chronic hepatitis C virus liver disease underwent evaluation, including argyrophilic nucleolar organizer regions proliferation index, and were followed up for 56.18 +/- 1.44 months.


RESULTS
Fifty-six patients had chronic hepatitis without cirrhosis and low argyrophilic nucleolar organizer regions proliferation index (< or =25%), 65 had hepatitis C virus-related cirrhosis and low argyrophilic nucleolar organizer regions proliferation index and 37 had hepatitis C virus-related cirrhosis and high argyrophilic nucleolar organizer regions proliferation index (>25%). Groups were similar for gender and viral genotype distribution. None of the patients with chronic hepatitis without cirrhosis developed hepatocellular carcinoma, compared with 6.1% of low argyrophilic nucleolar organizer regions proliferation index and 30.6% of high argyrophilic nucleolar organizer regions proliferation index (P = 0.002). By multivariable logistic regression analysis, the following parameters were independently associated with hepatocellular carcinoma development and used for the development of the statistical model: platelets (OR 0.98), gamma-globulins (OR 0.111), alanine aminotransferase/aspartate aminotransferase ratio (OR 0.07), serum ferritin (OR 1.0) and ultrasonographic pattern (coarse OR 2.9, coarse nodular OR 10.12). The statistical model properly allocated 95.9% of patients with low argyrophilic nucleolar organizer regions proliferation index and 72.2% of patients with high argyrophilic nucleolar organizer regions proliferation index.


CONCLUSIONS
The model, to be validated in large prospective studies, may help tailoring screening according to the risk of hepatocellular carcinoma development.
Azzaroli
F
F
Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna, Italy. azzaroli@med.unibo.it
Colecchia
A
A
Colecchi
A
A
Lodato
F
F
Trerè
D
D
Bacchi Reggiani
M L
ML
Festi
D
D
Prati
G M
GM
Accogli
E
E
Casanova
S
S
Derenzini
M
M
Roda
E
E
Mazzella
G
G
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000821:virology*; D049109:Cell Proliferation; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000473:pathology*; D022781:Hepatocytes / Q000473:pathology* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000821:virology*; D008113:Liver Neoplasms / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012044:Regression Analysis; D012307:Risk Factors; D016019:Survival Analysis