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Prediction model of hepatocarcinogenesis for patients with hepatitis C virus-related cirrhosis. Validation with internal and external cohorts

2006; Elsevier BV; Volume: 44; Issue: 6 Linguagem: Inglês

10.1016/j.jhep.2006.02.008

1600-0641

Kenji Ikeda, Yasuji Arase, Satoshi Saitoh, Masahiro Kobayashi, Takashi Someya, Tetsuya Hosaka, Norio Akuta, Yoshiyuki Suzuki, Fumitaka Suzuki, Hitomi Sezaki, Hiromitsu Kumada, Akihisa Tanaka, Hideharu Harada,

Liver Disease and Transplantation

Background/Aims To estimate hepatocarcinogenesis rates in patients with hepatitis C virus (HCV)-related cirrhosis, an accurate prediction table was created. Methods A total of 183 patients between 1974 and 1990 were assessed for carcinogenesis rate and risk factors. Predicted carcinogenesis rates were validated using a cohort from the same hospital between 1991 and 2003 (n=302) and an external cohort from Tokyo National Hospital between 1975 and 2002 (n=205). Results The carcinogenesis rates in the primary cohort were 28.9% at the 5th year and 54.0% at the 10th year. A proportional hazard model identified alpha-fetoprotein (≥20 ng/ml, hazard ratio 2.30, 95% confidence interval 1.55–3.42), age (≥55 years, 2.02, 95% CI 1.32–3.08), gender (male, 1.58, 95% CI 1.05–2.38), and platelet count (<100,000 counts/mm3, 1.54, 95% CI 1.04–2.28) as independently associated with carcinogenesis. When carcinogenesis rates were simulated in 16 conditions according to four binary variables, the 5th- and 10th-year rates varied from 9 to 64%, and 21–93%, respectively. Actual carcinogenesis rates in the internal and external validation cohorts were similar to those of the simulated curves. Conclusions Simulated carcinogenesis rates were applicable to patients with HCV-related cirrhosis. Since, hepatocarcinogenesis rates markedly varied among patients depending on background features, we should consider stratifying them for cancer screening and cancer prevention programs. To estimate hepatocarcinogenesis rates in patients with hepatitis C virus (HCV)-related cirrhosis, an accurate prediction table was created. A total of 183 patients between 1974 and 1990 were assessed for carcinogenesis rate and risk factors. Predicted carcinogenesis rates were validated using a cohort from the same hospital between 1991 and 2003 (n=302) and an external cohort from Tokyo National Hospital between 1975 and 2002 (n=205). The carcinogenesis rates in the primary cohort were 28.9% at the 5th year and 54.0% at the 10th year. A proportional hazard model identified alpha-fetoprotein (≥20 ng/ml, hazard ratio 2.30, 95% confidence interval 1.55–3.42), age (≥55 years, 2.02, 95% CI 1.32–3.08), gender (male, 1.58, 95% CI 1.05–2.38), and platelet count (<100,000 counts/mm3, 1.54, 95% CI 1.04–2.28) as independently associated with carcinogenesis. When carcinogenesis rates were simulated in 16 conditions according to four binary variables, the 5th- and 10th-year rates varied from 9 to 64%, and 21–93%, respectively. Actual carcinogenesis rates in the internal and external validation cohorts were similar to those of the simulated curves. Simulated carcinogenesis rates were applicable to patients with HCV-related cirrhosis. Since, hepatocarcinogenesis rates markedly varied among patients depending on background features, we should consider stratifying them for cancer screening and cancer prevention programs.