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Hepatocellular carcinoma - Prognosis and risk factors
Last reviewed: 06.07.2025
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The prognosis for hepatocellular carcinoma is usually extremely poor. The time interval between HBV or НСV infection and tumor development ranges from several years to many decades.
The rate of tumor growth varies and correlates with survival. In Italian patients with asymptomatic hepatocellular carcinoma, the time for tumor volume to double varied from 1 to 19 months, averaging 6 months. In Africans, the tumor grows more rapidly. The causes of this phenomenon are not precisely established; it may be genetically determined or due to nutritional deficiencies, aflatoxin ingestion, or late diagnosis due to frequent changes in residence among South African miners.
For small tumors (less than 3 cm in diameter), the 1-year survival rate is 90.7%, 2-year survival is 55%, and 3-year survival is 12.8%. In the case of massive infiltrative cancer, the prognosis is worse than in the case of nodular cancer. The presence of an intact capsule is a favorable sign. Although liver cirrhosis is the main risk factor for the development of hepatocellular carcinoma, large regeneration nodes (at least 1 cm in diameter) and hypoechoic regenerated nodes are especially prone to malignancy.
There is a correlation between the severity of liver disease and the risk of developing hepatocellular carcinoma. Patients with hepatocellular carcinoma younger than 45 years survive longer than older patients. Tumor infiltration of more than 50% of the liver, a decrease in serum albumin to 3 g% or less, and an increase in serum bilirubin are ominous signs.
The risk of developing hepatocellular carcinoma is higher in patients whose serum contains HBsAg or anti-НСV.
A combination of factors plays a role in increasing the risk of developing liver cirrhosis. In endemic areas, the risk of transformation of hepatitis to liver cirrhosis and development of hepatocellular carcinoma was thought to be increased by infection with both HBV and HCV. This opinion was based mainly on the use of first-generation tests. A study of specific viral markers (HCV-RNA and HBV-DNA) conducted in Spain showed that only 9 of 63 patients with hepatocellular carcinoma had coinfection with HBV and HCV. In the USA, coinfection with HCV and HBV was detected in 15% of patients with hepatocellular carcinoma. The literature data regarding the effect of alcohol on the development of hepatocellular carcinoma in patients with liver cirrhosis (caused by HCV infection) are contradictory: either this effect is minimal, or alcohol consumption increases the risk of developing hepatocellular carcinoma.
Lung metastases reduce the survival rate of patients.
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