Denise C Paranaguá-Vezozzo1, Suzane K Ono1, Mónica V Alvarado-Mora1, Alberto Q Farias1, Marlone Cunha-Silva2, João I D França2, Venancio A F Alves3, Morris Sherman4, Flair José Carrilho1. 1. São Paulo Clínicas Liver Cancer Group; Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil. 2. Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, SP, Brazil. 3. São Paulo Clínicas Liver Cancer Group; Department of Pathology, University of São Paulo School of Medicine, São Paulo, SP, Brazil. 4. Department of Gastroenterology, University of Toronto and University Health Network, Toronto, Canada.
Abstract
BACKGROUND AND AIM: 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. MATERIAL AND METHODS: 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. RESULTS: 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). CONCLUSION: 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)].
BACKGROUND AND AIM: 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. MATERIAL AND METHODS: 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. RESULTS: 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). CONCLUSION: 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)].
Authors: Rafael S Pinheiro; Daniel R Waisberg; Lucas S Nacif; Vinicius Rocha-Santos; Rubens M Arantes; Liliana Ducatti; Rodrigo B Martino; Quirino Lai; Wellington Andraus; Luiz A C D'Albuquerque Journal: Transl Gastroenterol Hepatol Date: 2017-08-29
Authors: Aline Lopes Chagas; Luciana Kikuchi; Paulo Herman; Regiane S S M Alencar; Claudia M Tani; Márcio Augusto Diniz; Vincenzo Pugliese; Manoel de Souza Rocha; Luiz Augusto Carneiro D'Albuquerque; Flair Jose Carrilho; Venancio A F Alves Journal: Clinics (Sao Paulo) Date: 2015-03-01 Impact factor: 2.365