| Resum: |
Background: The potential role of non-invasive tests (NITs) for liver fibrosis for hepatocellular carcinoma (HCC) prediction remains poorly known. Methods: Retrospective analysis of a NAFLD cohort from a single university hospital in Barcelona, Spain. Incidence rates and cumulative incidence for the overall cohort, as well as cirrhotic and non-cirrhotic patients were calculated. Logistic regression analyses were carried out to investigate risk factors of HCC. Results: From the entire cohort of 1040 patients, 996 patients (95. 8%) were analyzed, in whom 35 cases of HCC were detected, of which 26 (72. 4%) HCC incident cases were newly diagnosed during a median follow-up of 2. 5 (1. 9-3. 6) years. Two-hundred and thirty-one (23. 2%) were cirrhotic at baseline. With the exception of 2 (7. 7%) cases of HCC, the rest were diagnosed in cirrhotic patients. Overall HCC cumulative incidence was 9. 49 (95% CI 6. 4-13. 9) per 1000 person-years. The incidence rate for cirrhotic patients was 41. 2 (95% CI 27. 6-61. 6) per 1000 person-years and 0. 93 (95% CI 0. 23-3. 7) per 1000 person-years for patients without cirrhosis. Overall mortality was significantly higher amongst patients with HCC (4. 4% vs. 30. 8%, p < 0. 001). In patients with available liver biopsy (n = 249, 25%), advanced fibrosis (F3-F4) was significantly associated with higher HCC incidence, but not steatosis, lobular inflammation, nor ballooning. In the overall cohort, FIB-4 ≥1. 3 (HR 8. 46, 95% CI 1. 06-67. 4, p = 0. 044) and older age (HR 1. 06, 95% CI 1. 01-1. 11, p = 0. 025) were associated with increasing risk of HCC over time, whereas in cirrhotic patients predictors of HCC included decreasing values of albumin (HR 0. 34, 95% CI 0. 13-0. 87, p = 0. 024), platelets (HR 0. 98, 95% CI 0. 98-0. 99, p = 0. 001), and increasing values of liver stiffness (HR 1. 03, 95% CI 1. 00-1. 06, p = 0. 016). Conclusions: In a Spanish cohort of NAFLD patients, HCC was rare in non-cirrhotic patients. NITs might play a relevant role at predicting HCC. |
visitant ::
identificació
(Hospital Universitari Vall d'Hebron. Institut de Recerca)
