Hepatitis C virus genotype 1b as a major risk factor associated with hepatocellular carcinoma in patients with cirrhosis: A seventeen-year prospective cohort study

Authors

  • Savino Bruno,

    Corresponding author
    1. Liver Unit, Department of Medicine, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
    • Savino Bruno, Internal Medicine and Liver Unit, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Corso di Porta Nuova 23, 20121 Milan, Italy===

      Mario U. Mondelli, Centre for Hepatology, Department of Infectious Diseases, Fondazione Istitut di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Via Taramelli 5, 27100, Pavia, Italy===

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    • fax: +39 02 63632714

  • Andrea Crosignani,

    1. Department of Medicine, Azienda Ospedaliera San Paolo, University of Milan, Milan, Italy
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  • Patrick Maisonneuve,

    1. Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
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  • Sonia Rossi,

    1. Liver Unit, Department of Medicine, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
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  • Enrico Silini,

    1. Department of Pathology and Laboratory Medicine, Azienda Ospedaliera and University of Parma, Parma, Italy
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  • Mario U. Mondelli

    Corresponding author
    1. Centre for Hepatology and Infectious Diseases, Fondazione Istitut di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Pavia, Italy
    • Savino Bruno, Internal Medicine and Liver Unit, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Corso di Porta Nuova 23, 20121 Milan, Italy===

      Mario U. Mondelli, Centre for Hepatology, Department of Infectious Diseases, Fondazione Istitut di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo and University of Pavia, Via Taramelli 5, 27100, Pavia, Italy===

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    • fax: (39) 0382 526 450


  • Potential conflict of interest: Nothing to report.

Abstract

Hepatocellular carcinoma (HCC) is the most frequent cause of death in patients with hepatitis C virus (HCV)–induced cirrhosis. Despite a number of studies in different populations worldwide suggesting an association between HCV genotype 1 and the risk of HCC, no consensus has emerged yet on this matter, which is still controversial. In an attempt to clarify this issue, a prospective study of 163 consecutive HCV-positive patients with cirrhosis, who were enrolled between January 1989 and December 1990, was carried out. HCC occurrence was detected by ultrasound surveillance every 6 months. Independent predictors of HCC were assessed with a Cox regression analysis. After a median follow-up of 10.7 years, 44 [4.26/100/year, confidence interval (CI) = 3.11–5.68/100/year] of 104 patients infected with genotype 1b developed HCC versus 10 (1.69/100/year, CI = 0.82–3.09/100/year) of 52 patients infected with genotype 2a/c (P = 0.0001). Multivariate analysis showed that HCV genotype 1b was independently associated with HCC development [hazard ratio (HR) = 3.02, 95% CI = 1.40–6.53]. Other predictors of HCC were esophageal varices (HR = 2.15, 95% CI = 1.03–4.47), male gender (HR = 2.12, 95% CI = 1.10–4.11), and age over 60 years (HR = 5.96, 95% CI = 1.23–28.8). Conclusion: HCV genotype 1b is associated with a statistically significant higher risk of developing HCC. Patients with cirrhosis that are infected with this genotype require more intensive surveillance for the early detection and aggressive management of neoplasia. (HEPATOLOGY 2007.)

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