title: Development of hepatocellular carcinoma in elderly patients with chronic hepatitis C with or without elevated aspartate and alanine aminotransferase levels.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) in the elderly infected with hepatitis C virus (HCV) is expected to increase globally within the next two decades. The purpose of the study was to define the natural history of elderly patients with chronic hepatitis C needs in order to prevent HCC from arising in these patients.
  
  
  METHODS
  Treatment-naive patients aged >or=65 years with platelet counts >120 x 10(3)/mm(3) were classified as 120 with aspartate and alanine aminotransferase (ASAT and ALAT) levels <or=40 IU/l (group A) and 212 with either or both levels >or=41 (group B) and followed-up for 3 years or longer without antiviral treatment.
  
  
  RESULTS
  Cirrhosis and HCC developed more frequently in group B than in group A (p<0.001 for both). In particular, of the patients aged 65-69 years at entry, cirrhosis and HCC developed more frequently in group B than in group A (p<0.001 and p=0.001, respectively). Liver-related causes of death were more common in group B than in group A (20/34 (59%) versus 1/9 (11%), p=0.021). HCC developed more frequently in men than in women (p=0.033).
  
  
  CONCLUSIONS
  In elderly patients with chronic hepatitis C, cirrhosis and HCC develop more frequently in those with elevated transaminase levels than in those without elevated transaminase levels. Therefore, transaminase levels need to be suppressed below <or=40 IU/l, using antiviral treatments or other agents, in order to prevent cirrhosis and HCC arising in these patients. In view of rare liver-related deaths, aggressive antiviral treatment would not be necessary in the elderly with chronic hepatitis C who have normal transaminase levels.
authors.affiliation: Research Institute for Hepatology, Toranomon Hospital, Tokyo, Japan. vj7m-kbys@asahi-net.or.jp
authors.forename: Mariko
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Suzuki
authors.forename: Norio
authors.initials: N
authors.lastname: Akuta
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Hitomi
authors.initials: H
authors.lastname: Sezaki
authors.forename: Hiromi
authors.initials: H
authors.lastname: Yatsuji
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Hosaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Yasuji
authors.initials: Y
authors.lastname: Arase
authors.forename: Kenji
authors.initials: K
authors.lastname: Ikeda
authors.forename: Rie
authors.initials: R
authors.lastname: Mineta
authors.forename: Satomi
authors.initials: S
authors.lastname: Iwasaki
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Watahiki
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Miyakawa
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kumada
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000150:complications; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000150:complications; D008297:Male
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase