Risk factors for hepatocellular carcinoma in a cohort infected with hepatitis B or C
ABSTRACT The incidence of hepatocellular carcinoma (HCC) has increased in Australia in recent decades, a large and growing proportion of which occurs among a population chronically infected with hepatitis B virus (HBV) or hepatitis C virus (HCV). However, risk factors for HCC among these high-risk groups require further characterization.
We conducted a population-based cohort study using HBV and HCV cases notified to the New South Wales Health Department between 2000 and 2007. These were linked to cause of death data, HIV/AIDS notifications, and hospital records. Proportional hazards regression was used to identify significant risk factors for developing HCC.
A total of 242 and 339 HCC cases were linked to HBV (n = 43 892) and HCV (n = 83 817) notifications, respectively. For both HBV and HCV groups, being male and increasing age were significantly associated with risk of HCC. Increasing comorbidity score indicated high risk, while living outside urban areas was associated with lower risk. Hazard ratios for males were two to three times those of females. For both HBV and HCV groups, cirrhosis, alcoholic liver disease, and the interaction between the two were associated with significantly and considerably elevated risk.
This large population-based study confirms known risk factors for HCC. The association with older age highlights the potential impact of HBV and HCV screening of at-risk groups and early clinical assessment. Additional research is required to evaluate the impact of improving antiviral therapy on HCC risk.
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ABSTRACT: Liver stiffness (LS) is increased in liver cirrhosis, higher values being associated with complications, among them the development of hepatocellular carcinoma (HCC). However, LS values alone cannot accurately differentiate patients with HCC. Therefore, our aim was to study the performance of LS measurement data and common biomarkers for the detection of HCC in HCV related liver cirrhosis. We performed a case matching study comparing HCV cirrhotic patients with and without HCC (72 in each group) that were identical in terms of sex, age, BMI and duration of HCV infection. All patients underwent LS measurement, endoscopy, liver imaging and liver function tests. A multiple regression analysis was performed and a HCC detection model was calculated, which was further validated in another group of 40 HCV infected cirrhotics, of whom 52% had HCC. In the HCC group, LS was significantly higher (42 vs 27 kPa, p<0.0001). In the multivariate analysis higher values of LS, alanine-aminotransferase (ALAT), alpha-fetoprotein (AFP) and interquartile range (IQR) of LS measurements were independently associated with the presence of HCC (p<0.0001 for all parameters; Odds Ratios of 8.27, 1.01, 1.04 and 1.16, respectively). The detection model combining the four variables showed a good diagnostic performance in both training and validation groups, with AUROCs of 0.86 and 0.8, respectively. All variables were also positively correlated with tumor size. In HCV related cirrhosis, HCC is associated with increased LS and IQR values and high ALAT and AFP levels. By combining these four parameters into a regression model, liver cancer may be noninvasively predicted with good accuracy.Journal of gastrointestinal and liver diseases: JGLD 09/2013; 22(3):283-9. · 1.85 Impact Factor
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ABSTRACT: Abstract Background. Radiofrequency ablation (RFA) as a curative therapy for hepatocellular carcinoma (HCC) is widely used. The aim of this study was to investigate predisposing factors for HCC recurrence in patients with hepatitis B virus (HBV)-related small HCC after RFA. Methods. A total of 170 patients underwent percutaneous RFA for HBV-related small HCC (≤3 cm in diameter) from January 2008 to December 2010 at Samsung Medical Center. We analyzed the risk factors for recurrence of HCC after RFA. Results. The median follow-up duration was 27.0 months. A total of 89 patients (52%) experienced recurrence after percutaneous RFA. Cumulative recurrence-free rates after RFA at 1-, 3-, and 5 years were 81.3%, 47.2% and 35.7%, respectively. Univariate analysis showed that predisposing factors for HCC recurrence were the multinodularity (hazard ratio (HR) 2.22, p = 0.005), pre-RFA HBV DNA levels ≥2000 IU/mL (HR 1.61, p = 0.025), and Barcelona Clinic Liver Cancer stage A (HR 1.54, p = 0.046). The independent risk factors for recurrence by multivariate analysis were the multinodularity (HR 1.94, p = 0.026) and pre-RFA HBV DNA levels ≥2000 IU/mL (HR 1.57, p = 0.039). Conclusion. Multinodularity and HBV DNA levels were associated with the recurrence of HBV-related small HCC after RFA.Scandinavian Journal of Gastroenterology 12/2013; DOI:10.3109/00365521.2013.871745 · 2.33 Impact Factor
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ABSTRACT: Human T-lymphotropic virus type 1 (HTLV-1) may worsen the clinical course of hepatitis C virus (HCV) infection. The aim of this study was to investigate whether HTLV-1 coinfection influences the clinical characteristics of patients with HCV infection. This retrospective study included 523 consecutive patients from January 2001 to December 2010 with chronic liver disease due to HCV infection, in whom serum anti-HTLV-1 antibodies were examined. Among these patients, 265 were diagnosed with hepatocellular carcinoma (HCC). The seroprevalence of anti-HTLV-1 antibodies was significantly higher in patients with HCC (21.1 %) than those without HCC (10.5 %, P = 0.001). This significant difference was observed in female patients (29.5 vs. 8.5 %, P < 0.001), but not in male patients (16.5 vs. 12.9 %, P = 0.501). In multivariate analysis, anti-HTLV-1 antibody positivity was independently associated with HCC in female patients [odds ratio (OR), 5.029; 95 % confidence interval (95 % CI), 1.760-14.369; P = 0.003], in addition to age (≥65 years; OR, 10.297; 95 % CI, 4.322-24.533; P < 0.001), platelet count (<15 × 10(4)/μL; OR, 2.715; 95 % CI, 1.050-7.017; P = 0.039), total bilirubin (≥1 mg/dL; OR, 3.155; 95 % CI, 1.365-7.292; P = 0.007), and total cholesterol (≤160 mg/dL; OR, 2.916; 95 % CI, 1.341-6.342; P = 0.007). In contrast, HTLV-1 coinfection was not associated with HCC in male patients, although age, alcohol consumption, platelet count, and albumin were independently associated with HCC. HTLV-1 coinfection may contribute to the development of HCC in patients with chronic HCV infection, especially in females.Journal of Gastroenterology 01/2014; 49(12). DOI:10.1007/s00535-013-0928-5 · 4.02 Impact Factor