Incidence and Predictors of Hepatocellular Carcinoma in Patients With Cirrhosis

doi:10.1016/j.cgh.2007.02.039

Clinical Gastroenterology and Hepatology

Volume 5, Issue 8, August 2007, Pages 938-945.e4

https://doi.org/10.1016/j.cgh.2007.02.039 Get rights and content

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.

Section snippets

Study Setting and Data Collection

The Veterans Health Administration Northwest Network serves the health care needs of veterans at 8 facilities in 4 states (Alaska, Idaho, Oregon, and Washington). Selected patient data from these 8 health care facilities are stored in the Consumer Health Information and Performance Sets (CHIPS) database, which is designed for research, decision support, quality assurance, performance measurement, and testing guidelines. CHIPS contains data on all inpatient and outpatient diagnostic codes,

Results

Forty-one percent of the 2126 patients with cirrhosis had evidence of chronic HCV infection, 3.5% were positive for HBV surface antigen, and 35% were positive for hepatitis B core antibody (Table 1). In addition, 21% had type 2 diabetes mellitus, 25% had a serum total bilirubin level of 2.0 mg/dL or greater, 25% had a platelet count of 110 thousands/μL or less, 36% were overweight, 33% were obese, at least 72% were of non-Hispanic white ethnicity, and only 3% were women, consistent with the

Discussion

In a cohort of patients with cirrhosis who sought care in Veterans Affairs health care centers, independent predictors of developing hepatocellular carcinoma included HCV infection, HBV infection, presence of HBV core antibody, diabetes mellitus, increased BMI, and reduced platelet count (Table 1). The incidence of hepatocellular carcinoma varied by more than 20-fold based on the presence or absence of combinations of these predictors (Table 2).

Previous studies using surveillance programs for

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The success rate of scans and CE for the abdominal aorta during the aortic phase exhibited a significant decrease during dynamic CE-CT scans on patients with SM. Patients with SM may have reduced diagnostic ability with typical contrast injection protocols.
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A presumed pathological complete response of ruptured hepatocellular carcinoma showing retained intratumoral blood flow after trans-arterial chemo-embolization
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Prospective cross-sectional study conducted to determine the prevalence and pattern of alcohol consumption (AC) in patients with hepatocellular carcinoma (HCC) and to assess the utility of the AUDIT in HCC patients.
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: Supported by the American Liver Foundation and the American Association for the Study of Liver Diseases Jan Albrecht Award (G.N.I.), Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs (G.N.I.), and the General Medical Research Service of the Veterans Affairs Puget Sound Health Care System (S.P.L.).

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Original article—liver, pancreas, and biliary tractIncidence and Predictors of Hepatocellular Carcinoma in Patients With Cirrhosis

Section snippets

Study Setting and Data Collection

Results

Discussion

Clin Gastroenterol Hepatol

J Hepatol

Gastroenterology

Hepatology

Gastroenterology

Gastroenterology

Am J Gastroenterol

Clin Gastroenterol Hepatol

Am J Med

Am J Gastroenterol

Clin Gastroenterol Hepatol

Gastroenterology

Clin Gastroenterol Hepatol

Hepatology

Gastroenterology

Gastroenterology

Hepatocellular carcinoma: epidemiology, risk factors, and screening

Semin Liver Dis

Hepatocellular carcinoma in Italian patients with cirrhosis

N Engl J Med

Hepatitis C virus related cirrhosis: time to occurrence of hepatocellular carcinoma and death

Gut

Original article—liver, pancreas, and biliary tract
Incidence and Predictors of Hepatocellular Carcinoma in Patients With Cirrhosis