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Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis
Author(s) -
Velázquez Rosario F.,
Rodríguez Manuel,
Navascués Carmen A.,
Linares Antonio,
Pérez Ramón,
Sotorríos Nieves G.,
Martínez Isabel,
Rodrigo Luis
Publication year - 2003
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/jhep.2003.50093
Subject(s) - hepatocellular carcinoma , medicine , cirrhosis , gastroenterology , cumulative incidence , proportional hazards model , incidence (geometry) , hepatology , risk factor , multivariate analysis , prospective cohort study , transplantation , physics , optics
Better knowledge of the risk factors associated with the appearance of hepatocellular carcinoma (HCC) could improve the efficacy of surveillance programs. A total of 463 patients aged 40 to 65 years with liver cirrhosis in Child‐Pugh class A or B were included in a program of early diagnosis. The predictive value of different risk factors was evaluated using the Kaplan‐Meier method and Cox regression model. Thirty‐eight patients developed HCC. In the multivariate analysis, 4 variables showed an independent predictive value for the development of HCC: age 55 years or older, antibody to hepatitis C virus (anti‐HCV) positivity, prothrombin activity 75% or less, and platelet count less than 75 × 10 3 /mm 3 . According to the contribution of each of these factors to the final model, a score ranging between 0 and 4.71 points was constructed to allow the division of patients into 2 different risk groups. The low‐risk group included those with a score of 2.33 points or less (n = 270; 4 with HCC; cumulative incidence of HCC at 4 years, 2.3%), and the high‐risk group included those with a score greater than 2.33 (n = 193; 34 with HCC; cumulative incidence of HCC at 4 years, 30.1%) ( P = .0001). In conclusion, a simple score made up of 4 clinical and biological variables allowed us to distinguish 2 groups of cirrhotic patients at high and low risk for the development of HCC. We believe this score can be useful in establishing a subset of cirrhotic patients in whom a surveillance program for early detection of HCC could be unjustified.