医学
门静脉压
肝细胞癌
内科学
胃肠病学
肝硬化
门脉高压
静脉曲张
单变量分析
多元分析
作者
Cristina Ripoll,Roberto J. Groszmann,Guadalupe García‐Tsao,Jaime Bosch,Norman D. Grace,Andrew K. Burroughs,Ramón Planas,Àngels Escorsell,Juan Carlos García-Pagán,Robert W. Makuch,David Patch,Daniel S. Matloff
标识
DOI:10.1016/j.jhep.2009.01.014
摘要
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.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.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 cut-off; those who had an HVPG above this value had a 6-fold increase in the HCC incidence.Portal hypertension is an independent predictor of HCC development. An HVPG >10 mmHg is associated with a 6-fold increase of HCC risk.
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