title: Incidence of hepatocellular carcinoma in outpatients with cirrhosis in Brazil: A 10-year retrospective cohort study.
abstract: OBJECTIVE
  To determine the incidence of hepatocellular carcinoma (HCC) and the impact of HCC surveillance on early diagnosis and survival of cirrhotic outpatients.
  
  
  METHODS
  In this retrospective cohort study, cirrhotic outpatients undergoing HCC surveillance between March 2005 and March 2014 were analyzed. Exclusion criteria were HIV coinfection; previous organ transplantation; diagnosis of HCC at first consultation; missing data in the medical chart; and less than 1 year of follow-up. Surveillance was carried out every six months using ultrasound and serum alpha-fetoprotein determination. Ten-year cumulative incidence and survival were estimated through Kaplan-Meier analysis.
  
  
  RESULTS
  Four hundred and fifty-three patients were enrolled, of which 57.6% were male. Mean age was 55 years. Hepatitis C virus and heavy use of alcohol were the main etiologic agents of cirrhosis. HCC was diagnosed in 75 patients (16.6%), with an estimated cumulative incidence of 2.6% in the 1styear, 15.4% in the 5thyear, and 28.8% in the 10thyear. Median survival was estimated at 17.6 mo in HCC patients compared to 234 mo in non-HCC patients (P< 0.001). Early-stage HCC was more often detected in patients who underwent surveillance every 6 mo or less (P= 0.05). However, survival was not different between patients with early stagevsnon-early stage tumors [HR = 0.54 (0.15-1.89),P= 0.33].
  
  
  CONCLUSIONS
  HCC is a frequent complication in patients with cirrhosis and adherence to surveillance programs favors early diagnosis.
authors.affiliation: Marcelo Campos Appel-da-Silva, Suelen Aparecida da Silva Miozzo, Isabella de Azevedo Dossin, Cristiane Valle Tovo, Angelo Alves de Mattos, Graduate Program: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS 900150-170, Brazil.
authors.forename: Marcelo Campos
authors.initials: MC
authors.lastname: Appel-da-Silva
authors.affiliation: Marcelo Campos Appel-da-Silva, Suelen Aparecida da Silva Miozzo, Isabella de Azevedo Dossin, Cristiane Valle Tovo, Angelo Alves de Mattos, Graduate Program: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS 900150-170, Brazil.
authors.forename: Suelen Aparecida da Silva
authors.initials: SA
authors.lastname: Miozzo
authors.affiliation: Marcelo Campos Appel-da-Silva, Suelen Aparecida da Silva Miozzo, Isabella de Azevedo Dossin, Cristiane Valle Tovo, Angelo Alves de Mattos, Graduate Program: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS 900150-170, Brazil.
authors.forename: Isabella de Azevedo
authors.initials: IA
authors.lastname: Dossin
authors.affiliation: Marcelo Campos Appel-da-Silva, Suelen Aparecida da Silva Miozzo, Isabella de Azevedo Dossin, Cristiane Valle Tovo, Angelo Alves de Mattos, Graduate Program: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS 900150-170, Brazil.
authors.forename: Cristiane Valle
authors.initials: CV
authors.lastname: Tovo
authors.affiliation: Marcelo Campos Appel-da-Silva, Suelen Aparecida da Silva Miozzo, Isabella de Azevedo Dossin, Cristiane Valle Tovo, Angelo Alves de Mattos, Graduate Program: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS 900150-170, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Branco
authors.affiliation: Marcelo Campos Appel-da-Silva, Suelen Aparecida da Silva Miozzo, Isabella de Azevedo Dossin, Cristiane Valle Tovo, Angelo Alves de Mattos, Graduate Program: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS 900150-170, Brazil.
authors.forename: Angelo Alves
authors.initials: AA
authors.lastname: de Mattos
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000209:etiology; D008104:Liver Cirrhosis, Alcoholic / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Epidemiology; Hepatocellular carcinoma; Liver cirrhosis; Surveillance; Survival