Abstract
BackgroundThe incidence of hepatocellular carcinoma (HCC) and its association with hepatitis C (HCV) and hepatitis B virus (HBV) infections, FIB-4 index and liver enzymes was assessed in an area of the province of Naples covered by a population-based cancer registry.MethodsWe conducted a cohort investigation on 4492 individuals previously enrolled in a population-based seroprevalent survey on HCV and HBV infections. The diagnosis of HCC was assessed through a record linkage with the cancer registry. Hepatic metabolic activity was measured through serum alanine transaminase, aspartate aminotransferase, gamma-glutamyl-transferase, and platelet. The FIB-4 index was used as a marker of fibrosis. We computed HCC incidence rates (IR) for 100,000 (105) person-years of observation, and multivariable hazard ratios (HR) with 95 % confidence intervals (CI) to assess risk factors for HCC.ResultsTwenty two cases of HCC were diagnosed during follow-up (IR = 63.3 cases/105). Significantly increased HCC risks were documented in individuals with higher than normal liver enzymes and low platelet count; in the 239 HCV RNA-positives (HR = 61.8, 95 % CI:13.3–286); and in the 95 HBsAg-positives (HR = 75.0) –as compared to uninfected individuals. The highest FIB-4 score was associated with a 17.6-fold increased HCC risk.ConclusionsAn elevated FIB-4 index turned out to be an important predictor of HCC occurrence. Although the standard method to assess hepatic fibrosis in chronic hepatitis remains the histologic staging of liver biopsy specimen, the assessment of FIB-4 in HCV RNA-positive individuals may help in identifying the highest HCC-risk individuals who need anti-HCV treatment most urgently.
Highlights
The incidence of hepatocellular carcinoma (HCC) and its association with hepatitis C (HCV) and hepatitis B virus (HBV) infections, FIB-4 index and liver enzymes was assessed in an area of the province of Naples covered by a population-based cancer registry
Elevated HCC incidence rates (IR) were recorded among subjects aged 60 years or older (252.8/ 105 PY in those ≥70 years), in hepatitis C virus (HCV) RNA-positives/ HBsAg-negatives (909.3/105 PY), and in HBsAg-positive/ HCV-negative individuals (403.3/105 PY)
IRs of HCC were highly increased in cohort members with liver markers exceeding by three or more times the normal level, i.e., 1598 HCC cases/105 PY for alanine transaminase (ALT); 3539 cases/105 PY for Aspartate aminotransferase (AST); and 1006 cases/105 PY for γ-glutamyl transferase (γGT)
Summary
The incidence of hepatocellular carcinoma (HCC) and its association with hepatitis C (HCV) and hepatitis B virus (HBV) infections, FIB-4 index and liver enzymes was assessed in an area of the province of Naples covered by a population-based cancer registry. In Italy, population-based sero surveys showed a strong North–south geographic gradient [7,8,9,10], with high prevalence of HCV in the southern part of the country. In this area, elevated HCV prevalence rates were recorded among the older segment of the population (23 % of people aged 65 or more was HCV-positive in a population-based investigation conducted by our study group between 2003 and 2006) [11, 12]. Chronic HCV infection (i.e., HCV RNA–positivity) is more common than chronic HBV infection, and high HCV prevalence is mainly due to iatrogenic transmission in the past decades [12]
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