Prognostic Significance of Hemodynamic and Clinical Stages in the Prediction of Hepatocellular Carcinoma.
OBJECTIVE
Early identification of hepatocellular carcinoma (HCC) is associated with improved survival for patients with chronic liver disease (CLD). We evaluated the prognostic significance of hemodynamic stage (HS) and clinical stage (CS) in predicting HCC in CLD patients.


METHODS
Between January 2006 and May 2014, 801 patients with CLD who underwent hepatic venous pressure gradient (HVPG) measurement were prospectively enrolled. HS was classified by HVPG (mm Hg) as follows: HS-1 (HVPG≤6), HS-2 (6<HVPG≤10), HS-3 (10<HVPG≤12), HS-4 (12<HVPG≤20), and HS-5 (20<HVPG). CS was classified as follows: CS-0 (no cirrhosis), CS-1 (cirrhosis without varix), CS-2 (cirrhosis with varix), CS-3 (varix bleeding without other complications), CS-4 (first nonbleeding decompensating event), and CS-5 (any second decompensating event). The HCC development and risk factors for HCC were evaluated in all patients and patients with cirrhosis, respectively.


RESULTS
HCC developed in 53 patients (6.6%). The incidence densities of HCC according to HS-1 to HS-5 and CS-0 to CS-5 were 4, 16, 36, 45, and 49/1000 person years and 0, 15, 25, 33, 36, and 53/1000 person years of observation, respectively. Ascites aggravation [P=0.008, odd ratio (OR)=2.33], HVPG>12 mm Hg (P=0.033, OR=2.17), CS>2 (P=0.039, OR=2.36), and alpha-fetoprotein (AFP; P=0.017, OR=1.01) were significant predictors of HCC development in all patients. For patients with cirrhosis, ascites aggravation (OR=2.51), HVPG >12 mm Hg (OR=2.46), and CS >2 (OR=2.62) were correlated with HCC development. Areas under receiver operating characteristic curves of the prediction-model, CS, HVPG score, and AFP were 0.797, 0.707, 0.701, and 0.653, respectively.


CONCLUSIONS
HCC development correlates with advancing liver fibrosis or disease as measured by HS and CS. In addition, ascites aggravation and elevated AFP appears to be associated with increased incidence of HCC.
*Department of Internal Medicine, Hallym University College of Medicine, Chuncheon †Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang ‡Department of Internal Medicine, Hallym University Gangnam Sacred Heart Hospital §Department of Internal Medicine, Hallym University Gangdong Sacred Heart Hospital, Seoul ∥Department of Internal Medicine, Inje University Haeundae-Paik Hospital, Busan ¶Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea #Department of Internal Medicine, University Hospitals Case Medical Center, Cleveland **Department of Molecular and Cellular Physiology, University of Cincinnati College of Medicine, Cincinnati, OH.
Ki Tae
KT
Suk
Eun Jin
EJ
Kim
Dong Joon
DJ
Kim
Hyo Sun
HS
Kim
Chang Seok
CS
Bang
Tae Young
TY
Park
Gwang Ho
GH
Baik
Sung Eun
SE
Kim
Ji Won
JW
Park
Sang Hoon
SH
Park
Myung Seok
MS
Lee
Hyoung Su
HS
Kim
Myoung Kuk
MK
Jang
Seung Ha
SH
Park
Eunhee
E
Choi
Chang H
CH
Kim
Hotaik
H
Sung
Choong Kee
CK
Park
D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000401:mortality* / Q000473:pathology; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea; D016019:Survival Analysis