Perihepatic lymph node enlargement is a negative predictor of liver cancer development in chronic hepatitis C patients.
BACKGROUND
Perihepatic lymph node enlargement (PLNE) is a common ultrasound finding in chronic hepatitis C patients. Although PLNE is considered to reflect the inflammatory response to hepatitis C virus (HCV), its clinical significance remains unclear.


METHODS
Between December 2004 and June 2005, we enrolled 846 chronic hepatitis C patients in whom adequate ultrasound examinations had been performed. PLNE was defined as a perihepatic lymph node that was at least 1 cm in the longest axis by ultrasonography. We analyzed the clinical features of patients with PLNE and prospectively investigated the association between PLNE and hepatocellular carcinoma (HCC) development.


RESULTS
We detected PLNE in 169 (20.0%) patients. Female sex, lower body mass index (BMI), and HCV serotype 1 were independently associated with the presence of PLNE. However, there were no significant differences in liver function tests, liver stiffness, and hepatitis C viral loads between patients with and without PLNE. During the follow-up period (mean 4.8 years), HCC developed in 121 patients. Unexpectedly, patients with PLNE revealed a significantly lower risk of HCC development than those without PLNE (p = 0.019, log rank test). Multivariate analysis revealed that the presence of PLNE was an independent negative predictor of HCC development (hazard ratio 0.551, p = 0.042). In addition, the sustained viral response rate in patients who received interferon (IFN) therapy was significantly lower in patients with PLNE than in patients without PLNE.


CONCLUSIONS
Patients with PLNE had a lower risk of HCC development than those without PLNE. This study may provide new insights into daily clinical practice and the pathophysiology of HCV-induced hepatitis and hepatocarcinogenesis.
Department of Clinical Laboratory Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Hiromi
H
Hikita
Hayato
H
Nakagawa
Ryosuke
R
Tateishi
Ryota
R
Masuzaki
Kenichiro
K
Enooku
Haruhiko
H
Yoshida
Masao
M
Omata
Yoko
Y
Soroida
Mamiko
M
Sato
Hiroaki
H
Gotoh
Atsushi
A
Suzuki
Tomomi
T
Iwai
Hiromitsu
H
Yokota
Kazuhiko
K
Koike
Yutaka
Y
Yatomi
Hitoshi
H
Ikeda
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000821:virology*; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000145:classification / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology; D006801:Humans; D006965:Hyperplasia / Q000000981:diagnostic imaging / Q000821:virology; D008113:Liver Neoplasms / Q000821:virology*; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D014463:Ultrasonography; D019562:Viral Load; D055815:Young Adult