Incidence and Predictors of Hepatocellular Carcinoma in Patients With Cirrhosis

• Published in: Clinical gastroenterology and hepatology Vol. 5; no. 8; pp. 938 - 945.e4
• Main Authors: Ioannou, George N, Splan, Meaghan F, Weiss, Noel S, McDonald, George B, Beretta, Laura, Lee, Sum P
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2007
• Subjects: Carcinoma, Hepatocellular - epidemiology; Carcinoma, Hepatocellular - etiology; Carcinoma, Hepatocellular - pathology; Female; Follow-Up Studies; Gastroenterology and Hepatology; Hepacivirus - genetics; Hepacivirus - immunology; Hepatitis B Antibodies - analysis; Hepatitis B Surface Antigens - analysis; Hepatitis B virus - immunology; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - virology; Hepatitis C Antibodies - analysis; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - virology; Humans; Incidence; Liver Cirrhosis - complications; Liver Neoplasms - epidemiology; Liver Neoplasms - etiology; Liver Neoplasms - pathology; Male; Middle Aged; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; RNA, Viral - analysis; United States; United States; Consumer Health Information and Performance Sets; International Classification of Diseases, ninth revision; ICD-9; body mass index; CHIPS; hepatitis B virus; hepatitis C virus; adjusted hazard ratio; ahr; HCV; HBV; BMI
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2007.02.039

Background & Aims: Independent predictors of hepatocellular carcinoma in patients with cirrhosis are not well established. Methods: We created a cohort of 2126 patients (41% with hepatitis C virus [HCV] infection) who sought care from all Veterans Affairs health care centers in the northwest United States from 1994 to 2005 and who had a diagnosis of cirrhosis recorded in inpatient or outpatient medical records. Results: During a mean follow-up period of 3.6 years, 100 patients were diagnosed with hepatocellular carcinoma (incidence, 1.3 per 100 patient-years). Important predictors of hepatocellular carcinoma in multivariate models included HCV infection (adjusted hazard ratio [ahr], 3.0; 95% confidence interval [CI], 1.7–5.3); hepatitis B virus (HBV) surface antigen (ahr, 3.3; 95% CI, 1.4–7.7); HBV core antibody (ahr, 1.7; 95% CI, 1.1–2.8); obesity (ahr, 2.5; 95% CI, 1.3–4.9), and overweight (ahr, 2.8; 95% CI, 1.5–5.4) relative to patients with a body mass index of < 25 kg/m2 , diabetes (ahr, 1.5; 95% CI, 0.9–2.5), and low platelet count (relative to patients with a platelet count of >266 thousands/μL, the ahr was 2.1 [95% CI, 0.8–5.6] in patients with a platelet count of 180–266 thousands/μL, 3.3 [95% CI, 1.3–8.0] in patients with a platelet count of 111–179 thousands/μL, and the ahr was 4.7 [95% CI, 2.0–11.4] in patients with a platelet count of ≤110 thousands/μL). Conclusions: We identified 6 important predictors of hepatocellular carcinoma in multivariate models (including relatively novel predictors such as increased body mass index, HBV core antibody, and low platelet count), which suggest a means of predicting the risk of hepatocellular carcinoma in patients with cirrhosis and optimizing surveillance strategies.