Risk factors for hepatocellular carcinoma in patients with liver cirrhosis

OBJECTIVE: although cirrhosis is known to predispose toward hepatocellular carcinoma (HCC), there is no agreement on the factors that can influence th e risk for HCC in patients with cirrhosis. This study was designed to ident ify differences in cirrhosis-related risk factors for developing HCC in rel ation to epidemiological characteristics, stage of the disease and etiology . METHODS: 512 patients from southwestern Spain with Child-Pugh stage A or B cirrhosis were examined periodically by ultrasonography, and alpha-fetoprot ein (AFP) concentration was measured. RESULTS: the average length of follow-up was 37 months. A total of 52 cases of HCC were detected, which represented a risk of 17% after 5 years of fol low-up. The Cox model showed that the risk of HCC increased by 8% per year of increasing age. Male sex (relative risk: 3.4), hepatitis C virus infecti on (relative risk: 4.6), hepatitis B virus infection (relative risk: 2.9) a nd AFP Levels higher than 15 ng/ml (relative risk: 2.5) were also shown to be risk factors. Among alcoholic patients,only age (risk increased by 15% p er year), and hepatitis C virus infection (relative risk: 5.4) were risk fa ctors for HCC. However, in patients infected by hepatitis C virus, the main risk factors were age (relative risk increased by 8% per year), male sex ( relative risk: 3.9), co-infection with hepatitis B virus (relative risk: 4. 9), and increased AFP (relative risk: 2.8). Of the patients with HCC, 71% w ere infected with hepatitis C virus. Alcoholism, Child-Pugh stage and durat ion of cirrhosis did not increase the risk of the appearance of HCC. CONCLUSIONS: the risk of HCC increased to 17% after 5 years of follow-up in patients with Child-Pugh stage A or B cirrhosis. Hepatitis C virus infecti on was the main risk factor in patients with cirrhosis. Other risk factors were age, male sex, hepatitis B virus infection and altered Am level.