title: Laparoscopic findings of reddish markings predict hepatocellular carcinoma in patients with hepatitis B virus-related liver disease.
abstract: BACKGROUND
  For patients with chronic hepatitis due to hepatitis B virus (HBV), factors predicting hepatocellular carcinoma (HCC) other than high levels of HBV-DNA and alanine aminotransferase (ALT) are needed to prevent HCC development, as many patients with chronic HBV infection fulfill these conditions. The purpose of this study was to clarify factors predictive of HCC development for those patients.
  
  
  METHODS
  The study was a systematic cohort analysis of 303 consecutive patients with hepatitis B e-antigen, receiving laparoscopic examination for assessment of liver disease. Laparoscopic, histological, and clinical characteristics were investigated as related to HCC development.
  
  
  RESULTS
  HCC occurred in 27 patients during a mean follow-up of 8.0 ± 5.0 years, at the age of 37-72 years. Significant associations with HCC development were shown for liver cirrhosis, histological activity grade, reddish markings, and older age. Multivariate analysis revealed that HCC development was strongly associated with older age and male gender (P = 0.002 and P = 0.043, respectively). HCC occurred more frequently in patients of age ≥30 years even with early stage than in patients of age <30 years (P = 0.031). Severe reddish markings, a laparoscopic finding of widespread parenchymal destruction, were highly associated with HCC development in patients of age ≥30 years at diagnosis (odds ratio = 1.67, P = 0.034), while histological activity grade and ALT level were not (P = 0.075 and P = 0.69, respectively).
  
  
  CONCLUSIONS
  HCC development is associated with older age, male gender, and liver cirrhosis. Reddish markings, rather than histological activity or ALT level, can be useful to predict HCC for HBV patients of age ≥30 years.
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Shikata-cho, Okayama, Japan.
authors.forename: Bon
authors.initials: B
authors.lastname: Shoji
authors.forename: Fusao
authors.initials: F
authors.lastname: Ikeda
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Fujioka
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kobashi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yasunaka
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyake
authors.forename: Hidenori
authors.initials: H
authors.lastname: Shiraha
authors.forename: Akinobu
authors.initials: A
authors.lastname: Takaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Nouso
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Yamamoto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000410:Alanine Transaminase / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006513:Hepatitis B e Antigens / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology / Q000821:virology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult
chemical_list: D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase