Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis.
OBJECTIVE
A total of 213 patients with compensated cirrhosis, portal hypertension and no varices were included in a trial evaluating beta-blockers in preventing varices. Predictors of the development of hepatocellular carcinoma (HCC), including hepatic venous pressure gradient (HVPG) were analyzed.


METHODS
Baseline laboratory tests, ultrasound and HVPG measurements were performed. Patients were followed prospectively every three months until development of varices or variceal bleeding or end of the study in 09/02. The endpoint was HCC development according to standard diagnostic criteria. Univariate and multivariate Cox regression models were developed to identify predictors of HCC.


RESULTS
In a median follow-up of 58 months 26/213 (12.2%) patients developed HCC. Eight patients were transplanted and 28 patients died without HCC. Twenty-one (84%) HCC developed in patients with HCV. On multivariate analysis HVPG (HR 1.18; 95%CI 1.08-1.29), albumin (HR 0.34; 95%CI 0.14-0.83) and viral etiology (HR 4.59; 95%CI 1.51-13.92) were independent predictors of HCC development. ROC curves identified 10 mmHg of HVPG as the best cut-off; those who had an HVPG above this value had a 6-fold increase in the HCC incidence.


CONCLUSIONS
Portal hypertension is an independent predictor of HCC development. An HVPG >10 mmHg is associated with a 6-fold increase of HCC risk.
Ripoll
Cristina
C
Veterans Affairs CT Healthcare System, West Haven, CT 06516, USA.
Groszmann
Roberto J
RJ
Garcia-Tsao
Guadalupe
G
Bosch
Jaime
J
Grace
Norman
N
Burroughs
Andrew
A
Planas
Ramon
R
Escorsell
Angels
A
Garcia-Pagan
Juan Carlos
JC
Makuch
Robert
R
Patch
David
D
Matloff
Daniel S
DS
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014648:Varicose Veins / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control; D014690:Venous Pressure / Q000502:physiology
D000319:Adrenergic beta-Antagonists