Hepatitis C virus related cirrhosis: time to occurrence of hepatocellular carcinoma and death

Background-In patients with hepatitis C virus (HCV) infection and cirrhosis , long term outcome and the incidence of hepatocellular carcinoma (HCC) are still debated. Design-From January 1987 to January 1997, 416 patients (240 male, median ag e 57 years) with uncomplicated Child-Pugh A HCV related cirrhosis were foll owed in two Paris area centres from diagnosis of cirrhosis until death or r eference date (1 June 1998). The analysis used a three state disability mod el generalising the Cox model. Results-Of the 416 patients, 60 developed HCC with a five year rate of 13.4 % (95% confidence interval (CI) 9.0-17.8%) and 83 died (including 34 with H CC), with a five year death rate of 15.3% (95% CI 12.6-18.0%). By multivari able analysis, time to HCC relied on age (hazard ratio (HR) 1.05 per year; p=0.0005), male sex (HR 2.13; p=0.01), oesophageal varices (HR 2.36; p= 0.0 08), decreased platelet count (HR 0.99; p=0.03), and bilirubin level (HR 1. 01: p=0.003), while death after HCC was mainly related to tobacco consumpti on (HR 1.04; p=0.0006). In contrast, death free of HCC was dependent on age (HR 1.04; p=0.01), oesophageal varices (HR 2.75; p=0.001), low platelet co unt (HR 0.99; p=0.006), and albumin level (HR 0.90; p=0.0001). Conclusion-The incidence of HCC and mortality should be higher in these pat ients than previously stated, and prognostic factors of HCC and death are c losely related age and symptoms of portal hypertension.