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.