Hepatocellular carcinoma and survival in patients with... : Hepatology (original) (raw)

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Hepatocellular carcinoma and survival in patients with primary biliary cirrhosis

Shibuya, Akitaka*,1; Tanaka, Katsuaki2; Miyakawa, Hiroshi3; Shibata, Minoru4; Takatori, Masao5; Sekiyama, Kazuhiko6; Hashimoto, Naoaki7; Amaki, Shuuichi8; Komatsu, Tatsuji9; Morizane, Toshio10

1 Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara

2 Department of Internal Medicine, Yokohama City University

3 Department of Internal Medicine, Teikyo University

4 Department of Internal Medicine, Showa University

5 Department of Internal Medicine, St. Marianna University, Kawasaki

6 Department of Gastroenterology, Showa University Fujigaoka Hospital

7 Department of Gastroenterology, Tokyo Teishin Hospital

8 Department of Internal Medicine, Nihon University, Tokyo

9 Clinical Research Institute, Yokohama National Hospital, Yokohama

10 Department of Internal Medicine, Kanagawa Dental University, Yokosuka, Japan

E-mail:[email protected]

*Address reprint requests to: Department of Internal Medicine, Kitasato University School of Medicine, 1-15-1, Kitasato, Sagamihara, Kanagawa 228-8555, Japan. fax: (81) 42-749-8690.

Received October 29, 2001; accepted February 21, 2002; previously published online December 30, 2003

Abstract

The incidence of hepatocellular carcinoma (HCC) in patients with primary biliary cirrhosis (PBC) is not well known. The aims of this study are to determine HCC incidence and survival, and to identify risk factors associated with these outcomes in patients with PBC. We collected information on 396 patients with PBC at enrollment and followed-up from 6 to 271 months. They were all negative for hepatitis B and C virus markers. HCC was detected by scanning with ultrasonography, computed tomography, or both every 4 to 6 months. Life expectancy (LE) was approximated with the declining exponential approximation of LE. A total of 14 patients developed HCC. The cumulative appearance rate of HCC in patients with advanced-stage PBC (Scheuer's stage III or IV) was significantly higher than that for patients with early-stage (stage I or II) (12.3% and 7.7% by the tenth year, respectively. P = .021). Proportional hazards analysis showed 3 factors are independently associated with the development of HCC: age at the time of diagnosis, male gender, and history of blood transfusion. Age, male gender, and advanced-stage PBC were associated with survival, but HCC development was not. The disease-specific annual mortality rate was estimated to be 0.008 for women and 0.028 for men with advanced-stage PBC. In conclusion, HCC develops in old patients with advanced-stage PBC, but HCC does not affect the patients' survival.