Association between high serum alanine aminotransferase levels and more rapid development and higher rate of incidence of hepatocellular carcinoma inpatients with hepatitis C virus-associated cirrhosis

BACKGROUND, Many studies have demonstrated in animal experiments that persi stent inflammation may accelerate the development of carcinoma. In this art icle, the question of whether the persistent elevation of serum alanine ami notransferase (ALT) levels (which represents the inflammatory necrosis of h epatocytes) correlates with die development of hepatocellular carcinoma (HC C) was studied in patients with early stage hepatitis C virus (HCV)-associa ted cirrhosis. METHODS. Sixty-nine consecutive patients with biopsy proven HCV-associated cirrhosis (mostly Child's Stage A) who had been followed for >5 years for t he development of HCC, were studied. They were subdivided into 3 groups acc ording to their serum ALT levels: Group A was comprised of 28 patients whos e annual average serum ALT level was persistently high (greater than or equ al to 80 IU) (high ALT group), Group B was comprised of 28 patients whose a nnual average serum ALT level was persistently low (< 80 IU) (low ALT group ), and Group C was comprised of 13 unclassified patients. The patients had been studied prospectively with frequent ultrasonography and magnetic reson ance imaging or computed tomography for > 5 years. RESULTS, In the high ALT group HCC developed in 71.4% of patients compared with 25.0% in the low ALT group over the observation period (P < 0.005). Th e 5-year rate of incidence of HCC in the high ALT group was as high as 53.6 % compared with only 7.1% in the low ALT group (P < 0.001). The expected in terval between the diagnosis of cirrhosis and the development of HCC was 6. 0 +/- 0.7 years (mean +/- standard error) in the high ALT group and 12.7 +/ - 1.2 years in the low ALT group (P < 0.001). CONCLUSIONS, The results of the current study demonstrated that the develop ment of HCC was more rapid in the high ALT group with HCV-associated cirrho sis. Cancer 1999;86:589-95. (C) 1999 American Cancer Society.