Incidence and predictors of hepatocellular carcinoma in patients with cirrhosis

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/m(2), diabetes (ahr, 1.5; 95% CI, 0.9 - 2.5), and low platelet count (relative to patients with a platelet count of > 266 thousands/mu L, the ahr was 2.1 [95% CI, 0.8-5.6] in patients with a platelet count of 180 - 266 thousands/mu L, 3.3 [95% CI, 1.3 - 8.0] in patients with a platelet count of 111 - 179 thousands/mu L, and the ahr was 4.7 [95% CI, 2.0 - 11.4] in patients with a platelet count of <= 110 thousands/mu L). 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.