Occurrence of hepatocellular carcinoma and decompensation in western european patients with cirrhosis type B

Abstract

To examine the morbidity of compensated cirrhosis type B, a cohort of 349 Western European, white patients (86% men; mean age, 44 years) with biopsy‐proven cirrhosis was followed up for a mean period of 73 months and was studied for occurrence of hepatocellular carcinoma (HCC) and decompensation. At entry into the study all patients were tested for hepatitis B e antigen (HBeAg; 34% of patients were HBeAg‐positive) and antibody to hepatitis delta virus (anti‐HDV; 20% of patients were anti‐HDV‐positive); 48% of 252 patients tested were hepatitis B virus (HBV)‐DNA‐positive. During follow‐up HCC developed in 32 (9%) of the 349 patients and decompensation was observed in 88 (28%) of 317 tumor‐free patients. Five years after diagnosis, the probability of decompensation was 23%. After the first episode of decompensation the probability of survival was 35% at 5 years. Cox's regression analysis identified three variables that idependently correlated with HCC: age, serum levels of platelets, and liver firmness on physical examination. HBV (HBeAg or HBV‐DNA) and HDV (anti‐HDV) markers at presentation had no prognostic value for the development of HCC. In conclusion, a high proportion of patients with HBsAg‐positive compensated cirrhosis do not experience worsening of their condition for several years, but once decompensation occurs life expectancy is poor. European, white patients with compensated cirrhosis type B are at consistent risk for HCC. Prognostic factors for HCC reflect an advanced stage of cirrhosis and support the hypothesis that development of a tumor could be the likely consequence of long‐standing hepatic disease. (Hepatology 1995;21:77–82).