Hepatic venous pressure gradient predicts development of hepatocellular carcinoma independently of severity of cirrhosis

JOURNAL OF HEPATOLOGY

卷:50

Article

Ripoll, Cristina¹  Groszmann, Roberto J.¹  Garcia-Tsao, Guadalupe¹  Bosch, Jaime^2,3  Grace, Norman^4,5  Burroughs, Andrew^6,7  Planas, Ramon^3,8  Escorsell, Angels^2,3  Carlos Garcia-Pagan, Juan^2,3  Makuch, Robert¹  Patch, David^6,7  Matloff, Daniel S.⁵ 

[1] Yale Univ, Sch Med, VA CT Healthcare Syst, Digest Dis Sect 111H, West Haven, CT 06516 USA

[2] Hosp Clin Barcelona, Barcelona, Spain

[3] CIBERehd, Barcelona, Spain

[4] Brigham & Womens Hosp, Boston, MA 02115 USA

[5] Faulkner Hosp, Jamaica Plain, MA USA

[6] Univ London Royal Free Hosp, London NW3 2QG, England

[7] Sch Med, London, England

[8] Hosp Germans 8 Trias & Pujol, Badalona, Spain

关键词: Portal hypertension;    End-stage liver disease;    Liver cancer;    Albumin;    Predictive factors;    Multivariate analysis;   

DOI  :  10.1016/j.jhep.2009.01.014

来源: Elsevier

【 摘 要 】

Background/Aims: A total of 213 patients with compensated cirrhosis, portal hypertension and no varices were included in a trial evaluating beta-blockers in preventing varices. Predictors of the development of hepatocellular carcinoma (HCC), including hepatic venous pressure gradient (HVPG) were analyzed. Methods: Baseline laboratory tests, ultrasound and HVPG measurements were performed. Patients were followed prospectively every three months until development of varices or variceal bleeding or end of the study in 09/02. The endpoint was HCC development according to standard diagnostic criteria. Univariate and multivariate Cox regression models were developed to identify predictors of HCC. Results: In a median follow-up of 58 months 26/213 (12.2%) patients developed HCC. Eight patients were transplanted and 28 patients died without HCC. Twenty-one (84%) HCC developed in patients with HCV. On multivariate analysis HVPG (HR 1.18; 95%CI 1.08-1.29), albumin (HR 0.34; 95%CI 0.14-0.83) and viral etiology (HR 4.59; 95%CI 1.51-13.92) were independent predictors of HCC development. ROC curves identified 10 mmHg of HVPG as the best cutoff; those who had an HVPG above this value had a 6-fold increase in the HCC incidence. Conclusions: Portal hypertension is an independent predictor of HCC development. An HVPG >10 mmHg is associated with a 6-fold increase of HCC risk. Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.

【 授权许可】

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