Clinicalpathological analysis of risk factors for the development of hepatocellular carcinoma after surgery for esophageal varices due to underlying cirrhosis or pre-cirrhosis in the 397 patients

Abstract

Risk factors for the development of hepatocellular carcinoma (HCC) were investigated in 397 patients who underwent non-shunt operation for esophageal varices due to underlying cirrhosis or pre-cirrhosis between September 1979 and May 1995. Ninety-five of these patients developed HCC. The clinical characteristics of patients at the time of surgery for varices, stages (F0–F4) of the progression of fibrosis, and grades (A0–A3) of necroinflammatory activity in liver biopsy tissue obtained at surgery in 170 patients based on the New Inuyama Classification (Int. Hepatol. Commun. 6 (1996) 112) [1], were analyzed to investigate their relationship with the development of HCC. In addition, the levels of AST and ALT were followed every 3 months after surgery in 116 patients, and were divided into 2 groups at 80 IU/ml to compare the level of risk for the development of HCC. In liver biopsy tissue, group F4 ( n=68/152, 45%) showed a significantly higher ( P=0.0224) rate of appearance of HCC than group F3 ( n=3/18, 17%). Group F4 also tended to show a higher cumulative HCC appearance rate of 55% compared with 37% for group F3 at 10 years after surgery ( P=0.097). In regard to activity, the appearance rate of HCC in group A2+A3 ( n=52/112, 51%) was significantly higher ( P=0.0008) than that of HCC in group A1 ( n=14/58, 25%). The cumulative appearance rate (60%) of HCC in group A2+A3 was significantly higher than that (31%) in group A1 at 10 years after surgery ( P=0.0003). The appearance rate of HCC was significantly higher in the group ( n=33/44, 75%) with a mean AST level ⩾80 IU/ml than in the group ( n=41/72, 57%) with a mean AST level <80 IU/ml ( P=0.0496). A multivariate analysis of the risk factors for the development of HCC showed that necroinflammatory activity was a risk factor. These results suggested that the histopathologic classification (the New Inuyama Classification) of liver biopsy tissue from patients who underwent non-shunt operation for esophageal varices due to underlying cirrhosis or pre-cirrhosis is useful for predicting the development of HCC, to which the grades of necroinflammatory activity in particular are more closely related.