Hepatocellular carcinoma and survival in patients with autoimmune hepatitis (Japanese National Hospital Organization-autoimmune hepatitis prospective study).
OBJECTIVE
Although the outcome of autoimmune hepatitis (AIH) is generally good, the natural course and likelihood of progression to cirrhosis or hepatocellular carcinoma (HCC) remain undefined, and may vary by region and population structure. Our aims were to evaluate risk factors that contribute to poor outcome and particularly development of HCC in a prospective multicentric cohort study of AIH.


METHODS
The study group comprised 193 Japanese patients with AIH who were prospectively followed up at annual intervals between 1995 and 2008. The mean follow-up period was 8.0 ± 4.5 years.


RESULTS
Twenty-one (10.9%) patients had cirrhosis at presentation and a further 15 (7.8%) developed cirrhosis during the follow-up period. Survival rates were 94.2% at 10 years and 89.3% at 15 years. HCC was diagnosed in seven of the 193 patients. The presence of cirrhosis at presentation was a risk factor for HCC according to a Cox proportional hazard model, and the HCC-free survival rate was significantly lower in those with cirrhosis compared to those without cirrhosis according to Kaplan-Meier analysis.


CONCLUSIONS
Although the outcome of AIH is as good if not better among Japanese than for other populations, there was an increased risk of HCC in these patients. Cirrhosis at presentation was predictive of development of HCC in AIH in Japan.
Clinical Research Center, NHO Nagasaki Medical Center, Omura, Japan. migita@nmc.hosp.go.jp
Kiyoshi
K
Migita
Yukio
Y
Watanabe
Yuka
Y
Jiuchi
Yoko
Y
Nakamura
Akira
A
Saito
Michiyasu
M
Yagura
Hajime
H
Ohta
Masaaki
M
Shimada
Eiji
E
Mita
Taizo
T
Hijioka
Haruhiro
H
Yamashita
Eiichi
E
Takezaki
Toyokichi
T
Muro
Hironori
H
Sakai
Makoto
M
Nakamuta
Seigo
S
Abiru
Atsumasa
A
Komori
Masahiro
M
Ito
Hiroshi
H
Yatsuhashi
Minoru
M
Nakamura
Hiromi
H
Ishibashi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D019693:Hepatitis, Autoimmune / Q000401:mortality* / Q000473:pathology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000401:mortality / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult