Patients with ultrasonic coarse‐nodular cirrhosis who are anti‐hepatitis C virus‐positive are at high risk for hepatocellular carcinoma

• Published in: Cancer 1995-03, Vol.75 (6), p.1255-1262
• Main Authors: Tarao, Kazuo, Hoshino, Hiroshi, Shimizu, Akio, Ohkawa, Shinichi, Harada, Masaoki, Nakamura, Yoshiyasu, Ito, Yoshihiko, Tamai, Setsuo, Okamoto, Naoyuki
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antigens, Viral - analysis; anti‐HCV‐positive cirrhosis; bromodeoxyuridine; Carcinoma, Hepatocellular - etiology; Carcinoma, Hepatocellular - microbiology; Cell Division; Cell Transformation, Neoplastic; DNA - analysis; DNA synthesis; echo patterns in cirrhosis; Female; Hepatitis C Antigens; hepatocellular carcinoma; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - microbiology; Liver Cirrhosis - pathology; Liver Neoplasms - etiology; Liver Neoplasms - microbiology; Male; Middle Aged; Mitotic Index; Risk Factors; Ultrasonography; ultrasound findings in cirrhosis
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19950315)75:6<1255::AID-CNCR2820750607>3.0.CO;2-Q

Background. The relationships between echosonographic patterns of patients with cirrhosis who are antihepatitis C virus (HCV)‐positive, the DNA synthesis of hepatocytes, and the risk for HCC were studied. Methods. Thirty‐eight patients with anti‐C‐100 antibody‐positive and Child's grade A posthepatitic cirrhosis were studied. DNA synthesis activity was measured by a bromodeoxyuridine (BrdU, a thymidine analogue)‐labeling index (LI), using the BrdU‐anti‐BrdU in vitro method, and the patients were followed prospectively by frequent liver ultrasonography for 3 years. The ultrasound patterns were classified into fine, coarse, and coarse‐nodular (CN) patterns, and the reproducibility of the classification in practical use also was confirmed. Results. Of the 21 patients with high DNA synthesizing cirrhosis (BrdU LI ⩾ 1.5%), 10 (48%) showed coarse‐nodular, 5 (24%) coarse, and 6 (29%) fine pattern in ultrasonography. Conversely, of the 17 patients with low DNA synthesizing LC (BrdU LI < 1.5%), only 1 (6%) showed coarse‐nodular, 2 (12%) coarse, and 14 (82%) fine pattern.A significant relationship was found between the two groups of BrdU LI and ultrasound imaging patterns [P < 0.05). The incidence of CN pattern was significantly higher (P < 0.01) in the high DNA synthesizing group than in low DNA synthesizing group. Of the 11 patients with CN pattern by ultrasound imaging, 10 (91%) were in the high DNA synthesizing group, and 9 (82%) developed HCC during the follow‐up period, compared with 3 of 7 (43%) with coarse, and only one of 20 (5%) with fine pattern developed HCC. The incidence of HCC was significantly higher (P < 0.01) in patients with a CN cirrhosis pattern than in those with a fine pattern. Conclusions. In patients with cirrhosis who are anti‐HCV‐positive, the CN pattern by ultrasound imaging indicates increased DNA synthesis of hepatocytes and a high risk for developing HCC. Cancer 1995;75:1255‐62.