Paranaguá-Vezozzo Denise C, Ono Suzane K, Alvarado-Mora Mónica V, Farias Alberto Q, Cunha-Silva Marlone, França João I D, Alves Venancio A F, Sherman Morris, Carrilho Flair José
São Paulo Clínicas Liver Cancer Group; Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil.
Ann Hepatol. 2014 Jul-Aug;13(4):386-93.
The lack of information about hepatocellular carcinoma (HCC) in Brazil weakens health policy in preventing deaths from the illness. The aim of this study was to establish the cumulative incidence and the risk factors for hepatocellular carcinoma development in patients under a surveillance program.
884 patients with compensated cirrhosis were prospectively followed up for at least five years, from August 1998 until August 2008, with at least one annual ultrasonography liver examination and serum alpha fetoprotein (AFP) measurement.
Among 884 patients, 72 (8.1%) developed a tumor with a median follow up of 21.4 months. In the hepatocellular carcinoma group, hepatitis C virus infection was the major etiological factor (65.3%), 56.9% (41/72) were male and the mean average age was 57 ± 10 years. The annual incidence of hepatocellular carcinoma was 2.9%. 79.2% (57/72) of HCCs were detected within Milan Criteria, and the mean survival time was 52.3 months, significantly higher than for those outside Milan, with a mean time of 40.6 months (p = 0.0003).
The annual incidence of HCC among this large series of Brazilian cirrhotic patients was around 2.9% with a detection rate of 8.1%, or a cumulative incidence rate over five years of 14.3%. The three variables related to HCC risk were low serum albumin [HR: 0.518 (0.46-0.78)], high AFP > 20 ng/mL [HR: 3.16 (1.86-5.38)], and ethnicity (Brazilian-East Asian descendants vs. other mixed Brazilian ethnicities) [HR: 2.86 (1.48-5.53)].
巴西缺乏有关肝细胞癌（HCC）的信息，这削弱了预防该疾病死亡的卫生政策。本研究的目的是确定接受监测计划的患者中肝细胞癌发生的累积发病率和危险因素。
对884例代偿期肝硬化患者进行前瞻性随访，从1998年8月至2008年8月，至少随访五年，每年至少进行一次肝脏超声检查和血清甲胎蛋白（AFP）测量。
884例患者中，72例（8.1%）发生肿瘤，中位随访时间为21.4个月。在肝细胞癌组中，丙型肝炎病毒感染是主要病因（65.3%），56.9%（41/72）为男性，平均年龄为57±10岁。肝细胞癌的年发病率为2.9%。79.2%（57/72）的肝细胞癌在米兰标准范围内被检测到，平均生存时间为52.3个月，显著高于米兰标准范围外的患者，后者平均生存时间为40.6个月（p = 0.0003）。
在这一大组巴西肝硬化患者中，肝细胞癌的年发病率约为2.9%，检出率为8.1%，或五年累积发病率为14.3%。与肝细胞癌风险相关的三个变量是低血清白蛋白[风险比（HR）：0.518（0.46 - 0.78）]、高AFP>20 ng/mL[HR：3.16（1.86 - 5.38）]以及种族（巴西 - 东亚后裔与其他巴西混合种族）[HR：2.86（1.48 - 5.53）]。
