Model assesses HCC risk according to age, platelet counts

Model assesses HCC risk according to age, platelet counts

Mancebo A. Clin Gastroenterol Hepatol. 2013;11:95-101.

 January 16, 2013

A hepatocellular carcinoma surveillance program is not cost-effective for patients aged younger than 55 years who had high platelet counts, according to recent results.

In a prospective study, researchers assessed data on 450 patients aged 40 to 75 years with Child-Pugh class A or B alcoholic cirrhosis. The data included demographic information, as well as clinical and laboratory results collected at baseline and every 3 to 6 months for 5 years. Incidence of hepatocellular carcinoma (HCC) was observed within the cohort during a median follow-up of 42 months.

HCC occurred in 62 patients during follow-up, including 43 within the first 5 years. The annual incidence rate of HCC was 2.6%, with cumulative rates of 13.2% and 23.2% at 5 and 10 years, respectively. Multivariate analysis indicated independent associations between HCC development within 5 years and both advanced age (HR=2.39; 95% CI, 1.27-4.51 for patients aged 55 years and older) and platelet counts below 125 x 103/mm3 (HR=3.29; 95% CI, 1.39-7.85). The cohort was divided into three groups based on the presence or absence of one or both of these factors.

Patients without low platelet counts or advanced age (n=93) had an annual HCC incidence rate of 0.3%, compared with 2.6% among those with one factor (n=228) and 4.8% among those with both (n=129) (P<.0001 for difference). Similar results were observed when examining a subgroup of 140 patients with histologic cirrhosis diagnoses: Incidence rates were 0% for the group with neither factor, 2.7% for those with one and 3.4% for those with both factors.

“The annual incidence of HCC in patients with alcoholic cirrhosis Child-Pugh class A or B is around 2.5%, and the implementation of a surveillance program for early diagnosis of HCC is warranted in these patients,” the researchers wrote. “However, a model based on two simple variables, age and platelet count, is able to distribute these patients into three groups with different risk for the development of HCC.

“Patients who belong in [the low-risk] category probably should be included in a surveillance program only when they progress to moderate- or high-risk groups.”

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