Clinical and pathologic factors associated with development of hepatocellular carcinoma in patients with hepatitis virus-related cirrhosis: a long-term follow-up study
BMC Cancer
Meeting abstract Clinical and pathologic factors associated with development of hepatocellular carcinoma in patients with hepatitis virus-related cirrhosis: a long-term follow-up study
Vanessa Rosas-Camargo 2 3
José Luis Rodríguez-Díaz 2 3
Olynka Vega-Vega 1
Aniela Méndez-Reguera 2 3
Daniela Morales Espinosa 2 3
Jorge Luis Martínez- Tlahuel 2
Armando Gamboa-Domínguez 0
Oscar Arrieta 2 3
0 Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición , Mexico City , Mexico
1 Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición , Mexico City , Mexico
2 Department of Medical Oncology, Instituto Nacional de Cancerología , Mexico City , Mexico
3 Universidad Nacional Autónoma de México , Mexico City , Mexico
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Background
Hepatocellular carcinoma (HCC) represents >90% of
primary liver neoplasms and develops mainly in patients
with liver cirrhosis. Risk factor identification for
development of HCC in patients with cirrhosis possesses great
clinical relevance due to its high incidence and poor
prognosis when detected at advanced stages. The aim of our
study was to identify HCC development-associated risk
factors in a cohort of patients with hepatitis virus-related
chronic liver disease and cirrhosis.
Materials and methods
Patients with a diagnosis of hepatitis virus-related
cirrhosis from January 1980 to January 2000 were included.
Patients were followed with abdominal ultrasound and
determination of alpha-fetoprotein levels, physical
examination, and routine biochemical tests every 3–6 months.
The endpoint in this study was defined as development of
HCC. Liver histology was evaluated according to the
French METAVIR Cooperative Study Group (METAVIR)
score.
Results
Two hundred and eighty two patients met the inclusion
criteria; the majority of these (86%) had a serologic
diagnosis of hepatitis C virus, and only 14% had hepatitis B
virus at the time of diagnosis of cirrhosis, while 56 and
37% were classified as Child A and B, respectively, and
only 7% as Child C. Histological activity was mild in 59%
of patients, and moderate and severe in 41%. Mean
annual incidence was 1.87%, and 22 and 35% of patients
developed HCC at 10 and 15 years of follow-up,
respectively. Diagnosis of HCC was made by histopathology in
37% and by tumoral lesion-associated alpha-fetoprotein
elevation confirmed by imaging studies in 63%. In
multivariate analysis, we found three variables associated with
HCC: moderate to severe histological activity; platelet
count <105 × 103/mm3, and alpha-fetoprotein >5 ng/mL
(see Table 1). We divided patients into two groups
according to regression coefficient: low and high-risk; patients
assigned to the low-risk group showed 5-, 10-, and 15-year
HCC incidences of 3.4, 6.4, and 6.4%, respectively, in
contrast to patients from the high-risk group, who showed
incidences of 17.8, 33.5, and 56.8%, respectively.
Conclusion
We found three HCC-associated variables: histological
activity; platelet count and alpha-fetoprotein levels.
Patients with high risk for developing hepatocellular
carcinoma must be considered candidates for closer
followup.
Hazard ratio (95% confidence interval)
P value (log rank) (...truncated)