Risk Factors for Hepatocellular Carcinoma among Patients with Chronic Liver Disease

TLDR

The study aimed to identify potentially curable hepatocellular carcinoma cases by periodically screening outpatients with chronic hepatitis or compensated cirrhosis using ultrasonography and serum alpha‑fetoprotein measurements. A prospective cohort of 917 patients aged 40–69 years, followed from 1987 to 1991, was analyzed with a Cox proportional‑hazards model to determine risk factors for hepatocellular carcinoma. During follow‑up, 54 liver cancers developed, yielding a 3‑year cumulative risk of 12.5 % in cirrhotic patients and 3.8 % in chronic hepatitis patients; hepatitis B surface antigen increased risk nearly sevenfold (RR = 6.92) and hepatitis C antibody fourfold (RR = 4.09), while elevated alpha‑fetoprotein at enrollment also marked higher risk. Additional research is needed to clarify the impact of other risk factors such as alcohol consumption and smoking.

Abstract

To detect potentially curable cases of hepatocellular carcinoma, outpatients with chronic hepatitis or compensated liver cirrhosis who were seen at the Center for Adult Diseases (Osaka, Japan) were examined periodically by means of ultrasonography and measurement of serum alpha-fetoprotein. Risk factors for hepatocellular carcinoma were identified with a Cox proportional-hazards model.A total of 917 patients, 40 to 69 years old, were registered from May 1987 to March 1991. By the end of September 1991, liver cancer had developed in 54. The three-year cumulative risk of liver cancer was 12.5 percent for 240 patients with liver cirrhosis at enrollment and 3.8 percent for 677 patients with chronic hepatitis. Cox regression analysis showed that the risk of liver cancer was increased almost sevenfold in patients with hepatitis B surface antigen (rate ratio, 6.92; 95 percent confidence interval, 2.92 to 16.39) and fourfold in patients with hepatitis C antibody (rate ratio, 4.09; 95 percent confidence interval, 1.30 to 12.85). A high alpha-fetoprotein value at enrollment was also a risk marker for liver cancer.Patients with hepatitis C virus infection have a greatly increased risk of liver cancer. Further studies are required to clarify the roles of other risk factors, including drinking and smoking habits.