Predictive factors of risk of hepatocellular carcinoma in chronic hepatitis C

Eur J Intern Med. 2013 Dec;24(8):846-51. doi: 10.1016/j.ejim.2013.06.010. Epub 2013 Jul 10.

Abstract

Objective: To identify risk factors associated with the development of HCC and develop a score to identify high risk subgroups.

Methods: We conducted a follow-up study, with biannual ultrasound and alpha-fetoprotein screening, in an unselected cohort of patients with chronic hepatitis C referred for evaluation from the primary care.

Results: 863 patients with chronic hepatitis C were followed for an average of 82 months. 58 patients have developed HCC (7%). 34 (4%) patients were excluded from analysis due to detection of liver cancer at first evaluation. The demographic and clinical variables collected during the first 6 months of evaluation were analyzed retrospectively. Cox proportional multivariate regression analysis identified four independent factors related with HCC risk; age, alpha-fetoprotein level, gammaglobulin level and platelet count below 150,000/ml. A risk score formula (HCC-4) was constructed which lets us identify patients with low (annual incidence of 0.05%), intermediate (annual incidence of 0.6%) and high (annual incidence 2.6%) risk of HCC development with an area under the curve of 0.802.

Conclusion: The application of the score to the cohort let us identify a high-risk subgroup of patients with an annual HCC incidence of 2.6%, in which the screening would be cost-effective.

Keywords: Hepatocellular carcinoma; Liver cancer; Predictive score; Risk factors; Surveillance program; Viral hepatitis.

MeSH terms

  • Adult
  • Aged
  • Biomarkers, Tumor / metabolism*
  • Carcinoma, Hepatocellular / diagnostic imaging
  • Carcinoma, Hepatocellular / etiology*
  • Carcinoma, Hepatocellular / metabolism
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hepatitis C, Chronic / complications*
  • Hepatitis C, Chronic / diagnostic imaging
  • Humans
  • Liver / diagnostic imaging*
  • Liver Cirrhosis / diagnostic imaging
  • Liver Cirrhosis / etiology*
  • Liver Neoplasms / diagnostic imaging
  • Liver Neoplasms / etiology*
  • Liver Neoplasms / metabolism
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Ultrasonography
  • alpha-Fetoproteins / metabolism*

Substances

  • Biomarkers, Tumor
  • alpha-Fetoproteins