PREDICTIVE SCORE FOR THE DEVELOPMENT OF HEPATOCELLULAR-CARCINOMA AND ADDITIONAL VALUE OF LIVER LARGE-CELL DYSPLASIA IN WESTERN PATIENTS WITH CIRRHOSIS

The aim of this study was to identify high-risk patients for hepatocel lular carcinoma (HCC). Among 151 patients with histologically proven c irrhosis hospitalized from 1987 to 1990 and prospectively followed-up until June 1994, 31 developed HCC. We assessed the predictive value of 22 variables recorded at enrollment for HCC occurrence by the log ran k test and the Cox proportional hazards model. Six clinical and biolog ical variables summarized predictive information of HCC: age greater t han or equal to 50 years (P = .01), male (P = .01), large esophageal v arices (EV) (P = .03), prothrombin activity <70% (P = .04), serum alph a-fetoprotein (AFP) greater than or equal to 15 ng/L (P = .06), and an ti-hepatitis C virus antibodies (P = .08). A clinicobiological predict ive score identified two groups of patients at low (n = 67; 3-year cum ulative incidence, 0%) and high risk for HCC (n = 84; 3-year cumulativ e incidence, 24%). The predictive value of this score was confirmed us ing an independent population of 49 patients with cirrhosis. Furthermo re, Liver large-cell dysplasia (LCD) had an additional predictive valu e in high-risk patients (P = 10(-4)), which thus helped to define a su bgroup at very high risk for HCC (n = 12; 3-year cumulative incidence, 72%), In Western. patients with cirrhosis, a limited number of usual variables can identify a group of patients at, high risk for HCC. Amon g these patients, liver biopsy allows for the determination a subgroup of patients at very high risk for HCC requiring intensive screening o r preventive measures.