title: Annual incidence of hepatocellular carcinoma among patients with alcoholic cirrhosis and identification of risk groups.
abstract: OBJECTIVE
  The incidence of hepatocellular carcinoma (HCC) and associated risk factors in patients with alcoholic cirrhosis are not well defined. Surveillance for HCC among patients with cirrhosis who do not have hepatitis B is cost effective only if the expected risk of HCC exceeds 1.5% per year. We performed a prospective study to determine the incidence of HCC among patients with alcoholic cirrhosis and to identify risk factors.
  
  
  METHODS
  We analyzed data from a surveillance program of 450 patients, aged 40 to 75 years, with alcoholic cirrhosis of Child-Pugh class A or B; patients were enrolled at the liver unit of a tertiary center from September 1992 through March 2010. Data were collected on 20 demographic, clinical, and laboratory variables at the start of the study. Patients were examined every 3 to 6 months for 5 years to identify risk factors for HCC; incidence was determined from a median follow-up time of 42 months.
  
  
  RESULTS
  Over the follow-up period, 62 patients developed HCC (43 in the first 5 y of follow-up evaluation), with an annual incidence of 2.6%. By using multivariate analysis, age 55 years and older (hazard ratio, 2.39; 95% confidence interval, 1.27-4.51) and platelet counts less than 125 × 10(3)/mm(3) (hazard ratio, 3.29; 95% confidence interval, 1.39-7.85) were associated independently with the development of HCC. These variables were used to define 3 risk groups. The annual incidence of HCC in the group without either of these factors was 0.3% (n = 93), the annual incidence with 1 factor was 2.6% (n = 228), and the annual incidence with both factors was 4.8% (n = 129) (P < .0001).
  
  
  CONCLUSIONS
  The annual incidence of HCC among patients with alcoholic cirrhosis of Child-Pugh class A or B is around 2.5%. Age and platelet count can be used to classify the patients in 3 different risk groups for HCC development within the next 5 years.
authors.affiliation: Liver Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Alejo
authors.initials: A
authors.lastname: Mancebo
authors.forename: M Luisa
authors.initials: ML
authors.lastname: González-Diéguez
authors.forename: Valle
authors.initials: V
authors.lastname: Cadahía
authors.forename: María
authors.initials: M
authors.lastname: Varela
authors.forename: Ramón
authors.initials: R
authors.lastname: Pérez
authors.forename: Carmen A
authors.initials: CA
authors.lastname: Navascués
authors.forename: Nieves G
authors.initials: NG
authors.lastname: Sotorríos
authors.forename: Maribel
authors.initials: M
authors.lastname: Martínez
authors.forename: Luis
authors.initials: L
authors.lastname: Rodrigo
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D015994:Incidence; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008113:Liver Neoplasms / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D012307:Risk Factors