To determine the frequency of hepatocellular cancer in corticosteroid‐treated severe autoimmune chronic active hepatitis and to identify risk factors for its development, 124 patients who were selected by uniform criteria, treated comparably and followed systematically for 111 ± 6 months were evaluated. Hepatocellular cancer was diagnosed in three patients (2%) after 66, 99 and 174 months of observation, respectively. The incidence of hepatocellular cancer was 1 per 350 patient‐years of follow‐up. All three patients with hepa‐tocellular cancer had cirrhosis for at least 5 years. The frequency of neoplasm in patients with cirrhosis of at least 5 years' duration was 7%. The incidence of hepatocellular cancer in these patients with cirrhosis was 1 per 182 patient‐years of follow‐up, and the probability of tumor was 29% after 13 years. Late elevation of the serum α‐fetoprotein level was associated with the presence of neoplasm but normal levels did not exclude the diagnosis. We conclude that patients with corticosteroid‐treated severe autoimmune chronic active hepatitis are at risk for hepatocellular cancer. This risk is greatest in patients with cirrhosis for at least 5 years. Such patients are candidates for cancer surveillance.
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