Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis

被引:351
作者
Velázquez, RF
Rodríguez, M
Navascués, CA
Linares, A
Pérez, R
Sotorríos, NG
Martínez, I
Rodrigo, L
机构
[1] Hosp Cent Asturias, Dept Gastroenterol, Oviedo 33006, Asturias, Spain
[2] Hosp Cabuenes, Dept Gastroenterol, Gijon, Spain
关键词
D O I
10.1053/jhep.2003.50093
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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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页码:520 / 527
页数:8
相关论文
共 52 条
[1]   LIVER-CELL DYSPLASIA - PREMALIGNANT CONDITION [J].
ANTHONY, PP ;
VOGEL, CL ;
BARKER, LF .
JOURNAL OF CLINICAL PATHOLOGY, 1973, 26 (03) :217-223
[2]  
BEASLEY RP, 1988, CANCER, V61, P1942, DOI 10.1002/1097-0142(19880515)61:10<1942::AID-CNCR2820611003>3.0.CO
[3]  
2-J
[4]  
BEASLEY RP, 1981, LANCET, V2, P1129
[5]   Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis [J].
Bolondi, L ;
Sofia, S ;
Siringo, S ;
Gaiani, S ;
Casali, A ;
Zironi, G ;
Piscaglia, F ;
Gramantieri, L ;
Zanetti, M ;
Sherman, M .
GUT, 2001, 48 (02) :251-259
[6]   LIVER-CELL DYSPLASIA IS A MAJOR RISK FACTOR FOR HEPATOCELLULAR-CARCINOMA IN CIRRHOSIS - A PROSPECTIVE-STUDY [J].
BORZIO, M ;
BRUNO, S ;
RONCALLI, M ;
MELS, GC ;
RAMELLA, G ;
BORZIO, F ;
LEANDRO, G ;
SERVIDA, E ;
PODDA, M .
GASTROENTEROLOGY, 1995, 108 (03) :812-817
[7]  
BRUIX J, 1989, LANCET, V2, P1004
[8]   Clinical management of hepatocellular carcinoma.: Conclusions of the Barcelona-2000 EASL Conference [J].
Bruix, J ;
Sherman, M ;
Llovet, JM ;
Beaugrand, M ;
Lencioni, R ;
Burroughs, AK ;
Christensen, E ;
Pagliaro, L ;
Colombo, M ;
Rodés, J .
JOURNAL OF HEPATOLOGY, 2001, 35 (03) :421-430
[9]   PROGNOSTIC FACTORS OF HEPATOCELLULAR-CARCINOMA IN THE WEST - A MULTIVARIATE-ANALYSIS IN 206 PATIENTS [J].
CALVET, X ;
BRUIX, J ;
GINES, P ;
BRU, C ;
SOLE, M ;
VILANA, R ;
RODES, J .
HEPATOLOGY, 1990, 12 (04) :753-760
[10]  
COLOMBO M, 1989, LANCET, V2, P1006