Paranaguá-Vezozzo DC, Ono SK, Alvarado-Mora MV, Farias AQ, Cunha-Silva M, França JID, Alves VAF, Sherman M, Carrilho FJ

Language: English
References: 23
Page: 386-393
PDF size: 118.18 Kb.

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)].

REFERENCES

1. Colombo M. Should patients with chronic viral hepatitis be screened for hepatocellular carcinoma? Viral Hepatitis Rev 1995; 1: 65-75.

2. Yang JD, Roberts LR. Hepatocellular carcinoma: A global view. Nat Rev Gastroenterol Hepatol 2010; 7: 448-58.

3. Venook AP, Papandreou C, Furuse J, de Guevara LL. The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist 2010; 15: 5-13.

4. Carrilho FJ, Kikuchi L, Branco F, Goncalves CS, Mattos AA, Brazilian HCCSG. Clinical and epidemiological aspects of hepatocellular carcinoma in Brazil. Clinics 2010; 65: 1285-90.

5. Chagas AL, Kikuchi LO, Oliveira CP, Vezozzo DC, Mello ES, Oliveira AC, Cella LC, et al. Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and noncirrhotic patients? Braz J Med Biol Res 2009; 42: 958-62.

6. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology 2011; 53: 1020-2.

7. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D’Amico G, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33: 464-70.

8. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, Montalto F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 1996; 334: 693-9.

9. Goncalves CS, Pereira FE, Gayotto LC. Hepatocellular carcinoma in Brazil: report of a national survey (Florianopolis, SC, 1995). Rev Inst Med Trop Sao Paulo 1997; 39: 165-70.

10. Sangiovanni A, Del Ninno E, Fasani P, De Fasio C, Ronchi G, Romeo R, Morabito A, et al. Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance. Gastroenterology 2004; 126: 1005-14.

11. Jan CF, Chen CJ, Chen HH. Causes of increased mortality from hepatocellular carcinoma in high incidence country: Taiwan experience. J Gastroenterol Hepatol 2005; 20: 521-6.

12. Davila JA, Morgan RO, Richardson PA, Du XL, McGlynn KA, El-Serag HB. Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States. Hepatology 2010; 52: 132-41.

13. Michitaka K, Nishiguchi S, Aoyagi Y, Hiasa Y, Tokumoto Y, Onji M. Etiology of live cirrhosis in Japan: a nationwide survey. J Gastroenterol 2010; 45: 86-94.

14. Coelho GR, Vasconcelos KF, Vasconcelos JB, Barros MA, Costa PE, Borges GC, Junior JT, et al. Orthotopic liver transplantation for hepatocellular carcinoma: one center’s experience in the Northeast of Brazil. Transp Proc 2009; 41: 1740-2.

15. El-Serag HB. Hepatocellular carcinoma and hepatitis C in the United States. Hepatology 2002; 36: S74-S83.

16. El-Serag HB, Mason AC. Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 1999; 340: 745-50.

17. Kudo M, Izumi N, Kokudo N, Matsui O, Sakamoto M, Nakashima O, Kojiro M, et al. Management of Hepatocellular Carcinoma in Japan: Consensus-Based Clinical Practice Guidelines Proposed by the Japan Society of Hepatology (JSH) 2010 Updated Version. Dig Dis 2011; 29: 339-64.

18. Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 2004; 127: S35-S50.

19. Kikuchi LOO, Paranagua-Vezozzo DC, Chagas AL, Mello ES, Alves VA, Farias AQ, Pietrobon R, et al. Nodules less than 20 mm and vascular invasion are predictors of survival in small hepatocellular carcinoma. J Clin Gastroenterol 2009; 43: 191-5.

20. Ripoll C, Groszmann RJ, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, Planas R. Hepatic venous pressure gradient predicts development of Hepatocellular carcinoma independently of severity of cirrhosis. J Hepatol 2009; 50: 923-8.

21. European Association for the Study of the Liver, European Organization for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56: 908-43.

22. Singal A, Volk ML, Waljee A, Salgia R, Higgins P, Rogers MAM, Marrero JA. Meta-analysis: surveillance with ultrasound for early-stage hepatocellular carcinoma in patients with cirrhosis. Aliment Pharmacol Ther 2009; 30: 37-47.

23. Lee E, Edward S, Singal AG, Laviere MS, Volk M. Improving screening for hepatocellular carcinoma by incorporating data on levels of Alphafetoprotein, over time. Clin Gastroenterol Hepatol 2013; 11: 437-40.