title: Risk factors for survival and the development of hepatocellular carcinoma in patients with primary biliary cirrhosis.
abstract: OBJECTIVE
  Early diagnosis of hepatocellular carcinoma (HCC) is critical in the management of patients with primary biliary cirrhosis (PBC), since the prognosis of PBC has improved. The aim of this study was to investigate whether HCC development affects the prognosis of PBC and to identify the risk factors for HCC in Japanese patients with PBC.
  
  
  METHODS
  We compared the survival rates between patients with HCC and those without and analyzed the risk factors for HCC development in 210 patients with PBC who were followed up for a median period of 8.5 years.
  
  
  RESULTS
  HCC developed during follow-up in 11 patients (5.2%) and was diagnosed simultaneously at the time of diagnosis of PBC in five patients (2.4%) who were excluded from the analysis. A Kaplan-Meier analysis showed a significant difference in overall survival between the patients who did and did not develop HCC (p<0.001). A multivariate analysis revealed age (OR: 1.08, 95% confidence interval [CI]: 1.03-1.13, p=0.001), the albumin level (OR: 0.24, 95% CI: 0.10-0.56, p=0.001), the total bilirubin level (OR: 1.60, 95% CI: 1.09-2.36, p=0.017) and HCC development (OR: 2.97, 95% CI: 1.24-7.15, p=0.015) to be significant prognostic factors and identified only an advanced histological stage (Scheuer's classification III or IV, OR: 6.27, 95% CI: 1.80-21.83, p=0.004) to be a risk factor associated with HCC.
  
  
  CONCLUSIONS
  HCC development significantly affects the survival of patients with PBC, and an advanced histological stage is the only risk factor associated with HCC development. These results highlight the important role of liver fibrosis in hepatocarcinogenesis in patients with PBC.
authors.affiliation: Department of Hepatology and Pancreatology, Kawasaki Medical School, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Tomiyama
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Takenaka
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kodama
authors.forename: Miwa
authors.initials: M
authors.lastname: Kawanaka
authors.forename: Kyo
authors.initials: K
authors.lastname: Sasaki
authors.forename: Sohji
authors.initials: S
authors.lastname: Nishina
authors.forename: Naoko
authors.initials: N
authors.lastname: Yoshioka
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hara
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hino
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends