Several risk factors exist for
hepatocellular carcinoma in patients with post-
hepatitis cirrhosis (PHC), including
hypersplenism.
Splenectomy is a common but controversial procedure in the management of
hypersplenism, but its impact on
hepatocellular carcinoma (HCC) remains uncertain. We conducted a hospital-based study of PHC patients to identify potential risk factors, including a history of
splenectomy, which has been associated with progression from PHC to HCC. From 2002 to 2012, 2678 patients developed
hypersplenism secondary to PHC. Of these patients, 828 developed HCC and 1850 did not. Potential risk factors of HCC were determined by univariate and multivariate analyses to exclude confounding variables. Odds ratios (
ORs) and 95 % confidence intervals (95 % CIs) were determined for each factor. Many factors, such as liver function, platelet (PLT) counts, Child-Pugh class, and history of
hepatitis, were associated with progression to HCC. PHC patients with
hypersplenism who displayed elevated levels of
alanine transaminase (ALT),
aspartate transaminase (AST), γ-glutamyltransferase (GGT), ALK,
phosphatase, and prolonged prothrombin time (PT) had a significantly increased risk of HCC. However, the patients who had
splenectomy showed better liver function test results and less progression to HCC. In patients with PHC and
hypersplenism, abnormal levels of ALT, AST, ALP, and GGT and prolonged PT are risk factors of HCC.
Splenectomy, as the intervention method of
hypersplenism, is performed less frequently in patients who developed HCC than in patients who did not develop HCC. Therefore,
splenectomy may act as an independent factor that is significantly associated with HCC development.