Comparative Analysis of Outcomes of Patients with Hepatitis C Virus-Related Cirrhosis and Those with Hepatitis C Virus-Related Hepatocellular Carcinoma

Objective: We attempted to identify risk factors for the development of HCC by comparing the parameters of patients with HCV related liver cirrhosis without HCC (HCV-LC-without HCC) and those with HCV related liver cirrhosis plus HCC (HCV-LC-HCC).

Materials and Methods: We retrospectively analysed our database of 40 patients with HCV-LC without HCC and 42 patients with HCV-LC-HCC. A diagnosis of cirrhosis was based on the results of histological examination and/or elastography. HCC was diagnosed histologically or by the detection of consistent findings using at least two imaging techniques from among US, CT, or MRI. Hepatitis C virus infection was detected by enzyme linked immunosorbent assay (ELISA). Other baseline laboratory investigations such as CBC, liver function tests, including serum total bilirubin, ALT, AST, GGT, ALKP, AFP and serum albumin levels, and serum creatinine levels were also measured.

Results: HCC patients had significantly higher serum levels of NLR, PLR, GLR, ALKP and AFP and lower albumin levels, than the non-HCC patients. For the HCC patients, 33.3% had low AFP levels, 35.7% had macroscopic PVT and only 48.1% had a tumor diameter <5cm. Patients with high AFP, PVT and large tumor size had characteristic differences from those with low AFP, absent PVT and smaller tumor size.

Conclusions: Older age, male gender, increased levels of NLR, PLR, GLR, ALKP, AFP and decreased levels of albumin in HCV-related cirrhosis are associated with an increased risk of HCC. In addition, high levels of ALKP, very high levels of AFP (>1000 IU/ml), and presence of large (≥5 cm) tumors increase suspicion of presence of portal vein thrombosis. Consideration of these indicators in routine monitoring may be useful in early diagnosis and treatment of HCC in HCV-related cirrhosis.