title: Predictive factors of risk of hepatocellular carcinoma in chronic hepatitis C.
abstract: OBJECTIVE
  To identify risk factors associated with the development of HCC and develop a score to identify high risk subgroups.
  
  
  METHODS
  We conducted a follow-up study, with biannual ultrasound and alpha-fetoprotein screening, in an unselected cohort of patients with chronic hepatitis C referred for evaluation from the primary care.
  
  
  RESULTS
  863 patients with chronic hepatitis C were followed for an average of 82 months. 58 patients have developed HCC (7%). 34 (4%) patients were excluded from analysis due to detection of liver cancer at first evaluation. The demographic and clinical variables collected during the first 6 months of evaluation were analyzed retrospectively. Cox proportional multivariate regression analysis identified four independent factors related with HCC risk; age, alpha-fetoprotein level, gammaglobulin level and platelet count below 150,000/ml. A risk score formula (HCC-4) was constructed which lets us identify patients with low (annual incidence of 0.05%), intermediate (annual incidence of 0.6%) and high (annual incidence 2.6%) risk of HCC development with an area under the curve of 0.802.
  
  
  CONCLUSIONS
  The application of the score to the cohort let us identify a high-risk subgroup of patients with an annual HCC incidence of 2.6%, in which the screening would be cost-effective.
authors.affiliation: Internal Medicine Department, Universitary Hospital Virgen de la Victoria, Campus de teatinos S/N, 29010 Málaga, Spain. Electronic address: jc_gavilan@hotmail.com.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Gavilán
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ojeda
authors.forename: Rocio
authors.initials: R
authors.lastname: Arnedo
authors.forename: Susana
authors.initials: S
authors.lastname: Puerta
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000209:etiology*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology* / Q000378:metabolism; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins
keywords: Hepatocellular carcinoma; Liver cancer; Predictive score; Risk factors; Surveillance program; Viral hepatitis