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1057
INCIDENCE AND PREDICTIVE FACTORS OF HEPATOCELLULAR
CARCINOMA (HCC) IN A PROSPECTIVELY FOLLOWED
US COHORT OF PATIENTS AT RISK: HEPATOCELLULAR
CARCINOMA EARLY DETECTION STRATEGY (HEDS) STUDY
K Rajender Reddy1, Neehar D. Parikh2, Lewis R. Roberts3,
Myron E Schwartz4, Mindie H. Nguyen5, Alex Befeler6,
Stephanie Page-Lester7, Dale McLerran7, Sudhir Srivastava8,
Jo Ann Rinaudo9, Ziding Feng7 and Jorge A. Marrero10, (1)
University of Pennsylvania, (2)University of Michigan, (3)
Mayo Clinic Rochester, (4)Liver Cancer Program, Transplant,
Icahn School of Medicine at Mount Sinai, NY, (5)Division of
Gastroenterology and Hepatology, Stanford University, (6)
Department of Gastroenterology and Hepatology, Saint Louis
University, (7)Fred Hutchinson Cancer Research Center,
(8)Department of Medicine Division of GI, Hepatology and
Nutrition, Department of Pharmacology & Toxicology, Alcohol
Research Center, Hepatobiology & Toxicology Center,
University of Louisville, Louisville, KY, Robley Rex Louisville
VAMC, University of Louisville, (9)National Cancer Institute,
(10)University of Texas Southwestern Medical Center
Background: Worldwide, Hepatocellular carcinoma is a
common malignancy There are very few well-characterized
prospective cohorts of patients with cirrhosis assessed for
incidence and predictors of HCC The aims of this study were
to prospectively assess the incidence of HCC and determine
independent predictors of HCC in a US cohort of patients with
cirrhosis Methods: The multi-center NIH-sponsored HEDS
study of the Early Detection Research Network (EDRN)
prospectively enrolled patients at risk for HCC Enrolled
cirrhosis patients underwent standard surveillance for HCC
The database was reviewed to determine the incidence of
HCC and predictive factors of HCC Results: Participating US
Centers include University of Texas Southwestern, Stanford
University, Saint Louis University, Mayo Clinic, Mount Sinai
University Hospital, University of Michigan, and the University
of Pennsylvania; the Fred Hutchinson Cancer Research
Center in Seattle, WA, serves as the Data Management
Coordinating Center From 4/10/2013 through 12/7/2018,
1,559 patients were enrolled with median of 3 0 years’ history
of cirrhosis The majority were men (54 3%), were overweight
or obese (median body mass index [BMI] 30 1) and were
white (85 4%) 42 2% had history of HCV infection, 20 8%
had alcoholic liver disease, and 21 6% had nonalcoholic
steatohepatitis During a follow up of 3,202 person years,
there were 87 (55-BCLC early stage (0, A), 20 late stage
(B, C, D), and 12 unknown) incident cases of HCC (2 7%
incidence) In univariate analysis, baseline factors associated
with HCC were gender, obesity/BMI, age, smoking, family
history of liver cancer, CTP class, alpha fetoprotein (AFP),
albumin, AST, alkaline phosphatase, total bilirubin, INR,
MELD score, and esophageal varices In a multivariable
analysis including these predictors of HCC, effects which
were consistently significant were gender (p<0.005, male
OR=2 79; CI 1 62-4 80), age (per 5-year change, p<0 01,
OR=1.23; CI 1.06-1.42), BMI (p<0.02, [BMI ≥ 35] OR=2.32;
CI 1 04,5 16), and AFP (log(AFP), p<0 03, OR=1 45; CI
1.05-1.99); the model for these significant predictors had a
C-statistic of 0 707 Conclusion: In a prospectively followed
US cohort of cirrhosis patients at risk for HCC, the incidence
of HCC was 2 7% during a follow up of 3,202 person years
Independent and significant predictors of HCC were gender,
age, body mass index, and alpha fetoprotein. |
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发表于 2020-11-5 09:54