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The risk and predictive factors for developing liver cancer among patients with decompensated liver cirrhosis
1Division of Epidemiology, Nagoya.
Insights
Patients with liver cirrhosis and post-transfusion hepatitis face significantly higher liver cancer risks. Hepatitis B markers, AFP, age, and sex are key prognostic factors for liver cancer development.
Area of Science:
- Hepatology
- Oncology
- Epidemiology
Background:
- Decompensated liver cirrhosis and post-transfusion hepatitis are significant risk factors for hepatocellular carcinoma.
- Understanding the magnitude of risk and prognostic factors is crucial for early detection and prevention strategies.
Purpose of the Study:
- To quantify the risk of developing liver cancer in patients with decompensated liver cirrhosis and post-transfusion hepatitis.
- To identify prognostic factors associated with liver cancer development in these patient cohorts.
Main Methods:
- A three-year follow-up study linking patient records with the Aichi Cancer Registry.
- Inclusion of 1441 patients with decompensated liver cirrhosis and 343 with post-transfusion hepatitis.
- Questionnaire survey of 1068 decompensated cirrhosis patients to collect prognostic factor data.
Main Results:
- Patients with decompensated liver cirrhosis had a 64.9-fold increased liver cancer risk; post-transfusion hepatitis patients had a 9.4-fold increased risk compared to the general population.
- Hepatitis B e-antigen (HBe Ag) positivity, elevated alpha-fetoprotein (AFP) and GPT levels, older age, and male sex were associated with increased liver cancer risk.
- Multivariate analysis confirmed HBe Ag, AFP, sex, and age as significant predictors, while GPT, alcohol intake, and HBs Ag showed borderline significance.
Conclusions:
- Decompensated liver cirrhosis and post-transfusion hepatitis confer substantial increases in liver cancer risk.
- Hepatitis B virus markers (HBe Ag), specific biomarkers (AFP, GPT), demographic factors (age, sex), and lifestyle (alcohol intake) are important in predicting liver cancer development.
Abstract:
Patients with decompensated liver cirrhosis (n 1441) and those with post-transfusion hepatitis (n 343), whose medical expenses were subsidized by the Aichi Prefectural Government, were followed up for three years by record linkage with the Aichi Cancer Registry. During the follow-up period, 122 incident cases of liver cancer were identified. Compared with the general population, patients with decompensated liver cirrhosis were at a 64.9 times greater risk (50.5 times in males and 100.4 times in females) and those with post-transfusion hepatitis were at a 9.4 times greater risk (8.9 times in males and 13.7 times in females) of developing liver cancer. Information on prognostic factors for 1,068 patients with decompensated liver cirrhosis was also collected in a questionnaire survey by the physicians in charge. Patients positive to hepatitis B surface antigen (HBs Ag) and those positive to HBe Ag had a significantly increased risk of subsequent liver cancer. The risk of developing liver cancer was positively associated with base-line levels of GPT and AFP and age and, inversely associated with total alcohol intake and female sex. In multivariate analyses, the associations with HBe Ag, AFP, sex and age remained statistically significant, whereas the associations with GPT, total alcohol intake and HBs Ag were of borderline significance.