Published online Dec 15, 2024. doi: 10.4251/wjgo.v16.i12.4625
Revised: August 28, 2024
Accepted: October 9, 2024
Published online: December 15, 2024
Processing time: 187 Days and 8.6 Hours
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.
To identify specific risk factors contributing to HCC development in patients with cirrhosis.
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.
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.
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.
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.