期刊
JOURNAL OF HEPATOLOGY
卷 50, 期 5, 页码 923-928出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jhep.2009.01.014
关键词
Portal hypertension; End-stage liver disease; Liver cancer; Albumin; Predictive factors; Multivariate analysis
资金
- NIDDK NIH HHS [R01 DK046580-07, K24 DK002727, R01 DK46580, P30 DK034989] Funding Source: Medline
Background/Aims: A total of 213 patients with compensated cirrhosis, portal hypertension and no varices were included in a trial evaluating beta-blockers in preventing varices. Predictors of the development of hepatocellular carcinoma (HCC), including hepatic venous pressure gradient (HVPG) were analyzed. Methods: Baseline laboratory tests, ultrasound and HVPG measurements were performed. Patients were followed prospectively every three months until development of varices or variceal bleeding or end of the study in 09/02. The endpoint was HCC development according to standard diagnostic criteria. Univariate and multivariate Cox regression models were developed to identify predictors of HCC. Results: In a median follow-up of 58 months 26/213 (12.2%) patients developed HCC. Eight patients were transplanted and 28 patients died without HCC. Twenty-one (84%) HCC developed in patients with HCV. On multivariate analysis HVPG (HR 1.18; 95%CI 1.08-1.29), albumin (HR 0.34; 95%CI 0.14-0.83) and viral etiology (HR 4.59; 95%CI 1.51-13.92) were independent predictors of HCC development. ROC curves identified 10 mmHg of HVPG as the best cutoff; those who had an HVPG above this value had a 6-fold increase in the HCC incidence. Conclusions: Portal hypertension is an independent predictor of HCC development. An HVPG >10 mmHg is associated with a 6-fold increase of HCC risk. Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.
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