Predictive factors of risk of hepatocellular carcinoma in chronic hepatitis C

• A cohort study with 863 patients infected by hepatitis C virus
• A risk score formula (HCC-4) was constructed from multiple Cox regression analysis.
• It let us identify patients with low, intermediate and high risk of hepatocarcinoma.
• Age, AFP level, platelet count and gammaglobulin level were included in the score.
• The area under the curve (ROC) of this formula in our cohort was 0.802.

ObjectiveTo identify risk factors associated with the development of HCC and develop a score to identify high risk subgroups.MethodsWe conducted a follow-up study, with biannual ultrasound and alpha-fetoprotein screening, in an unselected cohort of patients with chronic hepatitis C referred for evaluation from the primary care.Results863 patients with chronic hepatitis C were followed for an average of 82 months. 58 patients have developed HCC (7%). 34 (4%) patients were excluded from analysis due to detection of liver cancer at first evaluation. The demographic and clinical variables collected during the first 6 months of evaluation were analyzed retrospectively. Cox proportional multivariate regression analysis identified four independent factors related with HCC risk; age, alpha-fetoprotein level, gammaglobulin level and platelet count below 150,000/ml. A risk score formula (HCC-4) was constructed which lets us identify patients with low (annual incidence of 0.05%), intermediate (annual incidence of 0.6%) and high (annual incidence 2.6%) risk of HCC development with an area under the curve of 0.802.ConclusionThe application of the score to the cohort let us identify a high-risk subgroup of patients with an annual HCC incidence of 2.6%, in which the screening would be cost-effective.