Predictive factors for hepatocellular carcinoma in type 1 autoimmune hepatitis.
OBJECTIVE
Hepatocellular carcinoma (HCC) is an uncommon but serious occurrence in autoimmune hepatitis. Our objective was to determine predictors for this neoplasm to improve screening strategies.


METHODS
Two hundred twenty-seven patients underwent hepatic ultrasonography and serum alpha fetoprotein determinations at 6-12-month intervals.


RESULTS
Nine patients developed HCC (4%), and each had cirrhosis > or =73 months prior to the malignancy (mean, 110 +/- 7 months). By univariate Cox analysis, features at accession associated with a higher risk of HCC were: male gender (Hazard Ratio [HR] 7.0, 95% Confidence Interval [CI] 1.87-26.1, P= 0.004), history of blood transfusion (HR 5.6, 95% CI 1.51-21.1, P= 0.01), thrombocytopenia (HR 7.3, 95% CI 1.89-28.3, P= 0.004), ascites (HR 23.8, 95% CI 4.65-121.8, P= 0.0001), esophageal varices (HR 7.9, 95% CI 1.96-31.8, P= 0.004), and any sign of portal hypertension (HR 19.1, 95% CI 3.91-93.3, P= 0.0003). Features after accession associated with a higher risk of malignancy were: treatment for > or =3 yr (HR 7.6, 95% CI 1.25-18.2, P= 0.02), worsening laboratory tests during corticosteroid therapy (HR 7.6, 95% CI 1.81-32.1, P= 0.006), and cirrhosis for > or =10 yr (HR 8.4, 95% CI 1.69-41.9, P= 0.009).


CONCLUSIONS
Male gender, features of portal hypertension, history of blood transfusions, immunosuppressive treatment for > or =3 yr, treatment failure, and cirrhosis of > or =10 yr duration identify patients at risk for HCC. These risk factors should focus screening in autoimmune hepatitis.
Division of Gastroenterology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Aldo J
AJ
Montano-Loza
Herschel A
HA
Carpenter
Albert J
AJ
Czaja
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
D000509:alpha-Fetoproteins