Incidence and predictors of hepatocellular carcinoma in patients with cirrhosis.
OBJECTIVE
Independent predictors of hepatocellular carcinoma in patients with cirrhosis are not well established.


METHODS
We created a cohort of 2126 patients (41% with hepatitis C virus [HCV] infection) who sought care from all Veterans Affairs health care centers in the northwest United States from 1994 to 2005 and who had a diagnosis of cirrhosis recorded in inpatient or outpatient medical records.


RESULTS
During a mean follow-up period of 3.6 years, 100 patients were diagnosed with hepatocellular carcinoma (incidence, 1.3 per 100 patient-years). Important predictors of hepatocellular carcinoma in multivariate models included HCV infection (adjusted hazard ratio [ahr], 3.0; 95% confidence interval [CI], 1.7-5.3); hepatitis B virus (HBV) surface antigen (ahr, 3.3; 95% CI, 1.4-7.7); HBV core antibody (ahr, 1.7; 95% CI, 1.1-2.8); obesity (ahr, 2.5; 95% CI, 1.3-4.9), and overweight (ahr, 2.8; 95% CI, 1.5-5.4) relative to patients with a body mass index of < 25 kg/m2, diabetes (ahr, 1.5; 95% CI, 0.9-2.5), and low platelet count (relative to patients with a platelet count of > 266 thousands/microL, the ahr was 2.1 [95% CI, 0.8-5.6] in patients with a platelet count of 180-266 thousands/microL, 3.3 [95% CI, 1.3-8.0] in patients with a platelet count of 111-179 thousands/microL, and the ahr was 4.7 [95% CI, 2.0-11.4] in patients with a platelet count of < or = 110 thousands/microL).


CONCLUSIONS
We identified 6 important predictors of hepatocellular carcinoma in multivariate models (including relatively novel predictors such as increased body mass index, HBV core antibody, and low platelet count), which suggest a means of predicting the risk of hepatocellular carcinoma in patients with cirrhosis and optimizing surveillance strategies.
Ioannou
George N
GN
Division of Gastroenterology, Department of Medicine, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, Washington 98108, USA. georgei@medicine.washington.edu
Splan
Meaghan F
MF
Weiss
Noel S
NS
McDonald
George B
GB
Beretta
Laura
L
Lee
Sum P
SP
D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000235:genetics / Q000276:immunology; D006510:Hepatitis B Antibodies / Q000032:analysis; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006515:Hepatitis B virus / Q000276:immunology; D019694:Hepatitis B, Chronic / Q000150:complications / Q000821:virology; D018937:Hepatitis C Antibodies / Q000032:analysis; D019698:Hepatitis C, Chronic / Q000150:complications / Q000821:virology; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States
D006510:Hepatitis B Antibodies; D006514:Hepatitis B Surface Antigens; D018937:Hepatitis C Antibodies; D012367:RNA, Viral