Endoscopic prediction of hepatocellular carcinoma by evaluation of bleeding esophageal varices
ABSTRACT Prognostic indicators for patients with liver cirrhosis accompanied by esophageal varices are hemorrhage of the varices and development of hepatocellular carcinoma (HCC). Although predictors for HCC have been reported, few studies have investigated the correlation between carcinoma development and endoscopic findings of bleeding varices. We examined whether endoscopic variceal findings such as form (F factor), color (C factor) and red color sign (RC factor) predict development of HCC.
This study included 124 patients with liver cirrhosis who received treatment for bleeding esophageal varices. Patients were followed up with blood chemistries including alpha-fetoprotein and by abdominal ultrasonography and computed tomography. The primary outcome measure of this study was the cumulative incidence of HCC after the treatment for esophageal varices. The secondary measure was whether endoscopic factors predicted the HCC development, and if so, which factors.
During follow-up, 32 of the 124 patients developed HCC. The cumulative carcinogenic rate after 3, 5 and 10 years was 11.8, 25.8 and 37.8%, respectively. Among the 32 patients who developed HCC, 29 (90.6%) had large esophageal varices (large F factor) prior to treatment of the varices. As the F factor increased, the percentage of patients who developed HCC also increased. In particular, independent predictors for HCC were: history of blood transfusion (p=0.037), presence of hepatitis C virus antibody (p=0.005), platelet count <7.5 x 10(4)/ml (p=0.004), alpha-fetoprotein level >10 ng/ml (p=0.030), and large F factor (F3) (p=0.002). Variceal RC and C factors were not independent predictors for carcinogenesis.
The endoscopic F factor rating of bleeding esophageal varices can be a significant predictive factor for HCC in patients with liver cirrhosis.
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