A long-term follow-up study on risk factors for hepatocellular carcinoma among Japanese patients with liver cirrhosis

To identify virological parameters (serostatus of hepatitis B surface antig en [HBsAg] and antibodies to hepatitis C virus [anti-HCV], HCV genotypes an d HCV-RNA titer) and other clinico-biological and lifestyle variables that may influence or predict the development of hepatocellular carcinoma (HCC) in cirrhosis, we followed 100 cirrhotic patients without HCC, who visited K yushu University Hospital between 1985 and 1987, until the end of 1995 (fol low-up rate: 98%; average follow-up period: 5.3 years). After elimination o f 4 patients who developed HCC or were censored within the initial 6 months , 37 (39%) out of 96 patients developed HCC during followup. As compared wi th HBsAg(+) patients, anti-HCV(+) HBsAg(-) patients demonstrated significan tly elevated HCC risk (adjusted hazard ratio [HR]=5.85, 95% confidence inte rval [CI] 1.65-20.67), Genotype I HCV infection was not associated with inc reased risk compared with genotype 2 (HR=0.64, 95% CI 0.21-1.99), For genot ype 1 HCV infection, patients with HCV-RNA levels <1 Meq/ml tended to prese nt lon er risk than patients with greater than or equal to 1 Meq/ml (P=0.03 ). Male sex, advanced Child's class, lower serum albumin, and higher serum aminotransferase and alpha-fetoprotein were also found to be strong predict ors. Overall, drinking and smoking habits were not associated with signific antly elevated risk. Among virological parameters, anti-HCV positivity and, possibly high HCV-RNA titer, were predictive of HCC occurrence in cirrhosi s in our clinical setting.