A MULTIVARIATE-ANALYSIS OF RISK-FACTORS FOR HEPATOCELLULAR CARCINOGENESIS - A PROSPECTIVE OBSERVATION OF 795 PATIENTS WITH VIRAL AND ALCOHOLIC CIRRHOSIS

To elucidate the appearance rates of hepatocellular carcinoma in cirrh osis and to assess the risk factors for hepatocellular carcinogenesis, we prospectively studied 795 consecutive patients with viral or alcoh olic cirrhosis for 2 to 17 yr (median of 5.8 yr). During the observati on period, hepatocellular carcinoma developed in 221 patients. Cumulat ive appearance rates of hepatocellular carcinoma were 19.4%, 44.3% and 58.2% at the end of the fifth, tenth and fifteenth years, respectivel y. When classified by the type of hepatitis virus infection, the appea rance rates of hepatocellular carcinoma in 180 patients with only HBsA g and in 349 patients with only antibodies to hepatitis C virus were 1 4.2% and 21.5% at the fifth yr, 27.2% and 53.2% at the tenth yr and 27 .2% and 75.2% at the fifteenth yr, respectively. Cox proportional haza rd model identified that alpha-fetoprotein levels (p = 0.00001), age ( p = 0.00067), positive hepatitis C virus antibodies (p = 0.00135), tot al alcohol intake (p = 0.00455) and indocyanine green retention rate ( p = 0.04491) were independently associated with the appearance rates o f hepatocellular carcinoma. Whereas age and indocyanine green retentio n rate were independent predictors for the appearance rate of liver tu mor in the subgroup of HBsAg-positive patients, alpha-fetoprotein leve ls, age and past alcohol consumption were independent predictors in th e group of hepatitis C virus antibody-positive patients. These epidemi ological results suggest that some differences exist in the activity a nd modes of cancer promotion between hepatitis B virus infection and h epatitis C virus infection.