Liver Unit, Hospital Universitario Central de Asturias, Oviedo, Spain; Department of Gastroenterology and Hepatology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Clin Gastroenterol Hepatol. 2013 Jan;11(1):95-101. doi: 10.1016/j.cgh.2012.09.007. Epub 2012 Sep 13.
BACKGROUND & AIMS: The incidence of hepatocellular carcinoma (HCC) and associated risk factors in patients with alcoholic cirrhosis are not well defined. Surveillance for HCC among patients with cirrhosis who do not have hepatitis B is cost effective only if the expected risk of HCC exceeds 1.5% per year. We performed a prospective study to determine the incidence of HCC among patients with alcoholic cirrhosis and to identify risk factors.
We analyzed data from a surveillance program of 450 patients, aged 40 to 75 years, with alcoholic cirrhosis of Child-Pugh class A or B; patients were enrolled at the liver unit of a tertiary center from September 1992 through March 2010. Data were collected on 20 demographic, clinical, and laboratory variables at the start of the study. Patients were examined every 3 to 6 months for 5 years to identify risk factors for HCC; incidence was determined from a median follow-up time of 42 months.
Over the follow-up period, 62 patients developed HCC (43 in the first 5 y of follow-up evaluation), with an annual incidence of 2.6%. By using multivariate analysis, age 55 years and older (hazard ratio, 2.39; 95% confidence interval, 1.27-4.51) and platelet counts less than 125 × 10(3)/mm(3) (hazard ratio, 3.29; 95% confidence interval, 1.39-7.85) were associated independently with the development of HCC. These variables were used to define 3 risk groups. The annual incidence of HCC in the group without either of these factors was 0.3% (n = 93), the annual incidence with 1 factor was 2.6% (n = 228), and the annual incidence with both factors was 4.8% (n = 129) (P < .0001).
The annual incidence of HCC among patients with alcoholic cirrhosis of Child-Pugh class A or B is around 2.5%. Age and platelet count can be used to classify the patients in 3 different risk groups for HCC development within the next 5 years.
酒精性肝硬化患者中肝细胞癌（HCC）的发病率及其相关危险因素尚不清楚。在没有乙型肝炎的肝硬化患者中，只有 HCC 的预期风险超过每年 1.5%时，对 HCC 进行监测才具有成本效益。我们进行了一项前瞻性研究，以确定酒精性肝硬化患者中 HCC 的发病率，并确定相关危险因素。
我们分析了 1992 年 9 月至 2010 年 3 月在一家三级中心肝脏科接受治疗的 450 例年龄在 40 至 75 岁之间、Child-Pugh 分级为 A 或 B 的酒精性肝硬化患者的监测计划数据。在研究开始时收集了 20 项人口统计学、临床和实验室变量的数据。在接下来的 5 年中，每 3 至 6 个月对患者进行检查以确定 HCC 的危险因素；中位随访时间为 42 个月，根据中位随访时间确定发病率。
在随访期间，有 62 例患者发生 HCC（前 5 年随访评估中 43 例），年发病率为 2.6%。使用多变量分析，年龄 55 岁及以上（风险比，2.39；95%置信区间，1.27-4.51）和血小板计数<125×103/mm3（风险比，3.29；95%置信区间，1.39-7.85）与 HCC 的发生独立相关。这些变量被用于定义 3 个风险组。没有这两个因素的患者 HCC 的年发病率为 0.3%（n=93），有 1 个因素的患者 HCC 的年发病率为 2.6%（n=228），有这两个因素的患者 HCC 的年发病率为 4.8%（n=129）（P<0.0001）。
Child-Pugh 分级为 A 或 B 的酒精性肝硬化患者 HCC 的年发病率约为 2.5%。年龄和血小板计数可用于将患者分为未来 5 年内 HCC 发展的 3 个不同风险组。
