Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2024; 16(12): 4625-4635
Published online Dec 15, 2024. doi: 10.4251/wjgo.v16.i12.4625
Risk factors for hepatocellular carcinoma in cirrhosis: A comprehensive analysis from a decade-long study
Da-Qiong Zhou, Jiang-Yu Liu, Feng Zhao, Jing Zhang, Li-Li Liu, Jian-Ru Jia, Zhen-Huan Cao
Da-Qiong Zhou, Jiang-Yu Liu, Jing Zhang, Li-Li Liu, Zhen-Huan Cao, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
Feng Zhao, Jian-Ru Jia, Hepatology Center, Baoding People’s Hospital, Baoding 071000, Hebei Province, China
Co-first authors: Da-Qiong Zhou and Jiang-Yu Liu.
Co-corresponding authors: Jian-Ru Jia and Zhen-Huan Cao.
Author contributions: Zhou DQ, Liu JY, and Zhao F analyzed the data and wrote the manuscript; Zhang J and Liu LL collected the data and contributed analytic tools; Jia JR and Cao ZH designed the research study and revised the manuscript.
Institutional review board statement: The protocol and consent form for the study were approved by the research ethics committee of Beijing Youan Hospital, Capital Medical University, Notification of Ethical Review Opinions (No. 2024051).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: The data used to support the findings are available from the corresponding author upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhen-Huan Cao, Doctor, Professor, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, No. 8 Xitoutiao, You’anmen Wai, Fengtai District, Beijing 100069, China. caozhenhuanyu@mail.ccmu.edu.cn
Received: May 9, 2024
Revised: August 28, 2024
Accepted: October 9, 2024
Published online: December 15, 2024
Processing time: 187 Days and 8.6 Hours
Abstract
BACKGROUND

Cirrhosis is a significant risk factor for the development of hepatocellular carcinoma (HCC). Variability in HCC risk among patients with cirrhosis is notable, particularly when considering the diverse etiologies of cirrhosis.

AIM

To identify specific risk factors contributing to HCC development in patients with cirrhosis.

METHODS

This retrospective study analyzed data from cirrhotic patients at Beijing Youan Hospital from January 1, 2012 to September 30, 2022 with at least 6 mo of follow-up. Patient demographics, medical histories, etiologies, and clinical characteristics were examined. Cox regression analysis was used to analyze correlations of the above parameters with hepatocarcinogenesis, while competing risk regression was used to estimate their adjusted hazard ratios accounting for death. The cumulative incidence was plotted over time.

RESULTS

Overall, 5417 patients with cirrhosis (median age: 54 years; 65.8% males) were analyzed. Hepatitis B virus (HBV) was the most common etiology (23.3%), with 25% (n = 1352) developing HCC over a 2.9-year follow-up period. Patients with multiple etiologies had the HCC highest incidence (30.3%), followed by those with HBV-related cirrhosis (29.5%). Significant risk factors included male sex, advanced age, hepatitis C virus (HCV) infection, elevated blood ammonia, and low platelet count. Men had a higher 5-year HCC risk than women (37.0% vs 31.5%). HBV, HCV, and HBV/HCV co-infected patients had 5-year risks of HCC of 45.8%, 42.9%, and 48.1%, respectively, compared to 29.5% in nonviral hepatitis cases, highlighting the significant HCC risk from viral hepatitis, especially HBV, and underscores the importance of monitoring these high-risk groups.

CONCLUSION

In conclusion, HBV-related cirrhosis strongly correlates with HCC, with male sex, older age, viral hepatitis, elevated blood ammonia, and lower albumin and platelet levels increasing the risk of HCC.

Keywords: Cirrhosis; Hepatocellular carcinoma; Risk factors; Hepatitis B virus; Competing risk analysis

Core Tip: Our retrospective analysis spanned a decade (January 1, 2012 to September 30, 2022) and included 5417 patients from Beijing Youan Hospital, Capital Medical University. Using Cox regression and competing risk regression models, we identified several key factors that significantly contributed to the risk of hepatocellular carcinoma in patients with cirrhosis. Specifically, this study underscores the increased association of hepatitis B cirrhosis with hepatocellular carcinoma incidence and highlights other significant risk factors, including male sex, advanced age, viral hepatitis-related cirrhosis, elevated blood ammonia, and lower albumin and platelet levels.