Stanford University School of Medicine, Stanford University Medical Center, Stanford, CA; Division of Epidemiology, Stanford University, Stanford University Medical Center, Stanford, CA.
BACKGROUND & AIMS:
We aimed to identify risk factors for hepatocellular carcinoma (HCC) in patients with cirrhosis in the US. We performed a prospective study to identify associations between etiologies of cirrhosis and ethnicity with HCC incidence.
We used convenience sampling to select a cohort of 379 patients with cirrhosis who visited the liver clinic at the Stanford University Medical Center from 2001 to 2009 (65% male, 75% white or Hispanic, and 20% Asian). Study endpoints were HCC diagnosis by histology or noninvasive criteria, liver transplantation, or last screening without HCC. Patients were followed, with ultrasound or computed tomographic imaging analyses and measurements of serum levels of α-fetal protein approximately every 6 months, for a median time of 34 months (range, 6-99 months).
The etiologies of cirrhosis in the cohort were 68% hepatitis C, 7% hepatitis B, and 25% non-viral. Forty-four patients (12%) were diagnosed with HCC during the follow-up period. Patients with cirrhosis related to viral hepatitis had a statistically significantly higher incidence of HCC than those with non-viral diseases in Kaplan-Meier analysis (P=.04). There was no statistically significant difference in HCC incidence between Asian and non-Asian patients. In a multivariate Cox proportional hazards model that included age, sex, ethnicity, etiology, and Child-Pugh-Turcotte score, viral cirrhosis was significantly associated with HCC, compared to non-viral cirrhosis (hazard ratio, 3.6; 95% confidence interval, 1.3-10.1; P=.02) but Asian ethnicity was not.
In a diverse cohort of patients in the US with cirrhosis, a viral etiology of cirrhosis was associated with increased incidence of HCC, but Asian ethnicity was not. These findings indicate the importance of cirrhosis etiology in determining risk for HCC.