Velazquez RF, Rodriguez M, Navascues CA, Linares A, Perez R, Sotorrios NG, Martinez I, Rodrigo L.: Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis.Hepatology. 2003 Mar;37(3):520-7. Gastroenterology, Hospital de Cabuenes, Gijon, Spain.
Better knowledge
of the risk factors associated with the appearance of hepatocellular
carcinoma (HCC) could improve the efficacy of surveillance programs.
A total of 463 patients aged 40 to 65 years with liver cirrhosis
in Child-Pugh class A or B were included in a program of early
diagnosis. The predictive value of different risk factors was
evaluated using the Kaplan-Meier method and Cox regression model.
Thirty-eight patients developed HCC. In the multivariate analysis,
4 variables showed an independent predictive value for the development
of HCC: age 55 years or older, antibody to hepatitis C virus (anti-HCV)
positivity, prothrombin activity 75% or less, and platelet count
less than 75 x 10(3)/mm(3). According to the contribution of each
of these factors to the final model, a score ranging between 0
and 4.71 points was constructed to allow the division of patients
into 2 different risk groups. The low-risk group included those
with a score of 2.33 points or less (n = 270; 4 with HCC; cumulative
incidence of HCC at 4 years, 2.3%), and the high-risk group included
those with a score greater than 2.33 (n = 193; 34 with HCC; cumulative
incidence of HCC at 4 years, 30.1%) (P =.0001). In conclusion,
a simple score made up of 4 clinical and biological variables
allowed us to distinguish 2 groups of cirrhotic patients at high
and low risk for the development of HCC. We believe this score
can be useful in establishing a subset of cirrhotic patients in
whom a surveillance program for early detection of HCC could be
unjustified.
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