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A Prospective Multicenter Study of Hepatocellular Carcinoma in
Italian Hemophiliacs With Chronic Hepatitis C
F. Tradati,
M. Colombo,
P.M. Mannucci,
M.G. Rumi,
C. De Fazio,
G. Gamba,
N. Ciavarella,
A. Rocino,
M. Morfini,
A. Scaraggi,
E. Taioli, and
the Study Group of the Association of Italian Hemophilia
Centers
From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center,
Fondazione Italiana Ricerca Cancro-University Research
Unit on Liver Cancer, Institute of Internal Medicine, and Epidemiology
Unit, University of Milan, Maggiore Hospital, Milan; Clinical Medicine
2, Instituto Ricovero e Cura a Carattere Scientfico Policlinic
Hospital, Pavia; Hemophilia and Thrombosis Center, Policlinic Hospital,
Bari; Department of Hematology, Nuovo Pellegrini Hospital, Naples;
Department of Hematology and Hemophilia Center, Careggi Hospital,
Florence; and Clinical Medicine and Department of Infectious Diseases,
Policlinic Hospital, Bari, Italy.
To assess the risk factors, natural history, and eligibility for
curative treatment of early-detected hepatocellular carcinoma (HCC),
385 hemophiliacs who were treated with blood or plasma derivates for at
least 10 years and had persistently elevated aminotransferase values
underwent an annual screening with an abdominal ultrasound examination
and measurement of the serum alpha-fetoprotein (AFP) level. Of these,
355 had serum antibody to hepatitis C virus (anti-HCV), 29 had anti-HCV
and hepatitis B surface antigen (HBsAg), and one had HBsAg alone; 141 had serum antibody to human immunodeficiency virus (anti-HIV). During
48 months of follow-up study, six patients developed HCC. All HCC patients had a HCV-related cirrhosis and had been exposed to HCV risk
at a median age of 40 years. All patients had a multicentric tumor,
which was not eligible for curative treatment. Univariate analysis
showed age, cirrhosis, and baseline AFP levels to be significantly
associated with an increased risk of HCC. By multivariate analysis, the
risk of HCC was infinite in patients with cirrhosis, 31.0 for those
with baseline AFP higher than 11 ng/mL, and 17.9 for those more than 45 years of age. In conclusion, the risk of cancer was greater for
patients infected later in life, particularly those with cirrhosis and
high AFP. Annual screening of hemophiliacs with ultrasound and AFP
fails to identify potentially curable tumors because the diagnosis is
made at a late stage of the disease.
Blood, Vol. 91 No. 4 (February 15), 1998:
pp. 1173-1177
© 1998 by The American Society of Hematology.
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