Abstract
BACKGROUNDPatients with liver cirrhosis are at significant risk of hepatocellular carcinoma (HCC) that may develop as well defined nodular lesions or as more aggressive infiltrating tumours.AIMTo compare prospectively risk factors...
Highlights
Patients with liver cirrhosis are at significant risk of hepatocellular carcinoma (HCC) that may develop as well defined nodular lesions or as more aggressive infiltrating tumours
When risk factors were assessed by multivariate analysis, they were clearly diVerent for these two types of HCC
Nodular HCC was associated with older age, longer duration, and more advanced stage of cirrhosis, and was unrelated to the aetiology of the underlying chronic liver disease, while development of an infiltrating and aggressive type of HCC was independent of duration or stage of cirrhosis and was strongly related to ongoing hepatitis B virus (HBV) infection or HBV and hepatitis C virus (HCV) coinfection
Summary
Patients with liver cirrhosis are at significant risk of hepatocellular carcinoma (HCC) that may develop as well defined nodular lesions or as more aggressive infiltrating tumours. Aim—To compare prospectively risk factors associated with nodular or infiltrating HCC in cirrhotic patients. Development of nodular HCC was associated with older age (p=0.0002; relative risk (RR) 3.1; 95% CI 1.6–5.2), longer duration (p=0.09; RR 2.6; 95% CI 1.8–3.4), and more advanced stage (p=0.002; RR 2.5; 95% CI 1.3–4.5) of cirrhosis but not with the aetiology of liver disease. Development of infiltrating HCC appeared to be unrelated to age or disease duration or stage, while it was associated with hepatitis B virus infection (p=0.07; RR 3.96; 95% CI 1.1–5.2) and with hepatitis B/hepatitis C virus coinfection (p=0.0007; RR 16.9; 95% CI 3.8–36.7). Nodular HCC was related to the cirrhotic process per se independent of aetiological factors and may depend on the proliferative activity within regenerative nodules, while the infiltrating form of HCC was linked to hepatitis B virus infection and may reflect more direct virus induced carcinogenesis
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