Rate of incidence of hepatocellular carcinoma in patients with compensated viral cirrhosis

• Published in: Cancer Vol. 85; no. 10; pp. 2132 - 2137
• Main Authors: Chiaramonte, Maria, Stroffolini, Tommaso, Vian, Alfredo, Stazi, Maria Antonia, Floreani, Annarosa, Lorenzoni, Umberto, Lobello, Salvatore, Farinati, Fabio, Naccarato, Remo
• Format: Journal Article
• Language: English
• Published: New York John Wiley & Sons, Inc 15.05.1999; Wiley-Liss
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Hepatocellular - epidemiology; Carcinoma, Hepatocellular - etiology; Carcinoma, Hepatocellular - virology; cirrhosis; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hepatitis B - complications; hepatitis B virus; Hepatitis C - complications; hepatitis C virus; hepatocellular carcinoma; Humans; Incidence; Liver; Liver Cirrhosis - complications; Liver Cirrhosis - virology; Liver Neoplasms - epidemiology; Liver Neoplasms - etiology; Liver Neoplasms - virology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Longitudinal Studies; Male; Medical sciences; Middle Aged; Population Surveillance; Risk Assessment; Sex Factors; Tumors; Human; Sex; Hepatic disease; Hepatocellular carcinoma; Malignant tumor; Incidence; Infection; Viral hepatitis B; Cirrhosis; Surveillance; Viral disease; Compensation; Risk factor; Digestive diseases; Predictive factor; Age; Viral hepatitis C
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19990515)85:10<2132::AID-CNCR6>3.0.CO;2-H

BACKGROUND Cirrhosis of viral etiology due to hepatitis B virus (HBV) or hepatitis C virus (HCV) infection is a risk factor for hepatocellular carcinoma (HCC). The current study evaluated the rate of incidence of HCC in patients with compensated cirrhosis of viral etiology. METHODS Two hundred fifty‐nine cirrhotic patients (66 hepatitis B surface antigen [HBsAg] positive, 166 HCV positive, and 27 HBsAg/HCV positive) were longitudinally examined every 6 months by serum α‐fetoprotein test and liver ultrasonography. The rates of incidence of HCC were calculated by the person‐years method. The Kaplan–Meier method was used to estimate the cumulative probability of HCC development. Differences in survival time were evaluated by a log rank test. Independent predictors of HCC development were estimated by Cox proportional hazard regression analysis. RESULTS During a mean follow‐up of 64.5 months, HCC developed in 51 (19.7%) patients: in 34 of 166 HCV positive subjects (20.5%) (mean follow‐up, 66.3 months), in 6 of 66 of those HBsAg positive (9.1%) (mean follow‐up, 55.06 months), and in 11 of 27 of those with dual HBsAg/HCV infection (40.7%) (mean follow‐up, 76.4 months). The rate of incidence of HCC per 100 person‐years of follow‐up was 3.7 in HCV positive subjects, 2.0 in those HBsAg positive, and 6.4 in those with dual infection. Cumulative HCC appearance rates in HBsAg positive, HCV positive, and HBsAg/HCV positive subgroups were 10%, 21%, and 23% at 5 years, 16%, 28%, and 45% at 10 years, and 16%, 40%, and 55% at 13 years, respectively. Multivariate analysis indicated that age >50 years (hazard risk [HR], 4.5; 95% confidence interval [CI] = 2.1–9.4), male gender (HR, 2.8; 95% CI = 1.1–5.3), and HBsAg/HCV coinfection (HR, 2.3; 95% CI = 1.1–4.6) were independent predictors of HCC development. CONCLUSIONS These findings confirm that male gender and more advanced age (>50 years) are risk factors for HCC in patients with cirrhosis. Furthermore, the data indicate that subjects with dual HBsAg/HCV infection are at highest risk for HCC. Surveillance programs for early detection of HCC should focus especially on these patients. Cancer 1999;85:2132–7. © 1999 American Cancer Society. The authors found that the rate of incidence of hepatocellular carcinoma (HCC) in patients with compensated cirrhosis varies according to the virus; it is higher in subjects who are anti–hepatitis C virus positive compared with those who are hepatitis B surface antigen positive and highest in those with dual infection. Male gender and age >50 years were both independent predictors of HCC development.