Hepatitis C virus genotype 1b as a major risk factor associate with hepatocellular carcinoma in cirrhotic patients: a seventeen-year prospective study

Hepatocellular carcinoma (HCC) is the most frequent cause of death in patients with hepatitisC virus (HCV)–induced cirrhosis. Despite a number of studies in different populations worldwide suggesting an association between HCV genotype 1 and the risk of HCC, no consensus has emerged yet on this matter, which is still controversial. In an attempt to clarify this issue, a prospective study of 163 consecutive HCV-positive patients with cirrhosis, who were enrolled between January 1989 and December 1990, was carried out. HCC occurrence was detected by ultrasound surveillance every 6 months. Independent predictors of HCC were assessed with a Cox regression analysis. After a median follow-up of 10.7 years, 44 [4.26/100/year, confidence interval (CI) _ 3.11-5.68/100/year] of 104 patients infected with genotype 1b developed HCC versus 10 (1.69/100/year, CI_0.82-3.09/100/year) of 52 patients infected with genotype 2a/c (P _ 0.0001). Multivariate analysis showed that HCV genotype 1b was independently associated with HCC development [hazard ratio (HR) _ 3.02, 95% CI _ 1.40-6.53]. Other predictors of HCC were esophageal varices (HR _ 2.15, 95% CI_1.03-4.47), male gender (HR_2.12, 95% CI_1.10-4.11), and age over 60 years (HR _ 5.96, 95% CI _ 1.23-28.8). Conclusion: HCV genotype 1b is associated with a statistically significant higher risk of developing HCC. Patients with cirrhosis that are infected with this genotype require more intensive surveillance for the early detection and aggressive management of neoplasia.