title: Risk factors for hepatocellular carcinoma in Japanese patients with autoimmune hepatitis type 1.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is occasionally seen even in patients with autoimmune hepatitis (AIH) without prior infection either with hepatitis C virus (HCV) or hepatitis B virus. The aim of this study was to identify the incidence of and risk factors for HCC with AIH in a large-scale population with a long-term follow-up in Japan.
  
  
  METHODS
  One hundred and eighty patients diagnosed with AIH were enrolled (F/M = 159/21; mean age, 59.9 years; mean observation period, 80.2 months). Patients with positive HCV antibody/serum HCV RNA and/or positive HBs Ag were excluded. Initial treatment included immunosuppressant therapy (n = 147), other drugs (n = 28), and no drug (n = 5). Patients underwent abdominal ultrasonography at intervals of 3-6 months during observation. Patients' demographic factors, biochemical data, liver histology, medications, response to treatment, and complications were evaluated in relation to HCC.
  
  
  RESULTS
  During the observation period, six patients (3.3%) developed HCC. Univariate analysis showed that risk factors for HCC were cirrhosis at diagnosis with AIH (p = 0.0002), absence of a treatment response (p = 0.033), abnormal alanine aminotransferase (ALT) at the final observation (p = 0.0002), and diabetes (p = 0.0015). Multivariate analysis showed that risk factors for HCC were cirrhosis at diagnosis of AIH (odds ratio 4.08) and abnormal ALT at final observation (odds ratio 3.66).
  
  
  CONCLUSIONS
  This retrospective study showed that cirrhosis at diagnosis of AIH and abnormal ALT at final observation were independently associated with HCC development. It is important to pay attention to the presence of cirrhosis at diagnosis of AIH and to normalize ALT.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan. terukoh@med.kurume-u.ac.jp
authors.forename: Teruko
authors.initials: T
authors.lastname: Hino-Arinaga
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ide
authors.forename: Ryoko
authors.initials: R
authors.lastname: Kuromatsu
authors.forename: Ichiro
authors.initials: I
authors.lastname: Miyajima
authors.forename: Kei
authors.initials: K
authors.lastname: Ogata
authors.forename: Reiichiro
authors.initials: R
authors.lastname: Kuwahara
authors.forename: Akiko
authors.initials: A
authors.lastname: Hisamochi
authors.forename: Takuji
authors.initials: T
authors.lastname: Torimura
authors.forename: Michio
authors.initials: M
authors.lastname: Sata
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001379:Azathioprine / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000209:etiology*; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D002756:Cholagogues and Choleretics; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014580:Ursodeoxycholic Acid; D011239:Prednisolone; D000410:Alanine Transaminase; D001379:Azathioprine