Endoscopic Prediction of Hepatocellular Carcinoma by Evaluation of Bleeding Esophageal Varices

[Guest guest]

Original Paper

Endoscopic Prediction of Hepatocellular Carcinoma by Evaluation of Bleeding

Esophageal Varices

Hisashi Nakayamaa, Hideki Masudaa, Hiroshi Miyakea, Tadatoshi Takayamaa,

Eise Yokoyamab

aDepartment of Surgery and

bDepartment of Public Health, Nihon University School of Medicine, Tokyo,

Japan

Address of Corresponding Author

Digestion 2004;70:233-239 (DOI: 10.1159/000082895)

--------------------------------------------------------------------------------

Key Words

Endoscopic findings

Liver cirrhosis

Esophageal varices

Hepatocellular carcinoma

Prognostic indicator for liver cirrhosis

Red color sign

--------------------------------------------------------------------------------

Abstract

Background: Prognostic indicators for patients with liver cirrhosis

accompanied by esophageal varices are hemorrhage of the varices and

development of hepatocellular carcinoma (HCC). Although predictors for HCC

have been reported, few studies have investigated the correlation between

carcinoma development and endoscopic findings of bleeding varices. We

examined whether endoscopic variceal findings such as form (F factor), color

(C factor) and red color sign (RC factor) predict development of HCC.

Methods: This study included 124 patients with liver cirrhosis who received

treatment for bleeding esophageal varices. Patients were followed up with

blood chemistries including -fetoprotein and by abdominal ultrasonography

and computed tomography. The primary outcome measure of this study was the

cumulative incidence of HCC after the treatment for esophageal varices. The

secondary measure was whether endoscopic factors predicted the HCC

development, and if so, which factors. Results: During follow-up, 32 of the

124 patients developed HCC. The cumulative carcinogenic rate after 3, 5 and

10 years was 11.8, 25.8 and 37.8%, respectively. Among the 32 patients who

developed HCC, 29 (90.6%) had large esophageal varices (large F factor)

prior to treatment of the varices. As the F factor increased, the percentage

of patients who developed HCC also increased. In particular, independent

predictors for HCC were: history of blood transfusion (p = 0.037), presence

of hepatitis C virus antibody (p = 0.005), platelet count <7.5 × 104/ml (p =

0.004), -fetoprotein level >10 ng/ml (p = 0.030), and large F factor (F3) (p

= 0.002). Variceal RC and C factors were not independent predictors for

carcinogenesis. Conclusion: The endoscopic F factor rating of bleeding

esophageal varices can be a significant predictive factor for HCC in

patients with liver cirrhosis.