AIM: To assess the predictive value of the insulinlike growth factor 2 (Igf2) methylation profile for the occurrence of Hepatocellular Carcinoma (HCC) in hepatitis C (HCV) cirrhosis.METHODS: Patients with: (I) biopsy-proven compensated HCV cirrhosis; (2) available baseline frozen liver sample; (3) absence of detectable HCC; (4) regular screening for HCC; (5) informed consent for genetic analysis were studied.After DNA extraction from liver samples and bisulfite treatment,unbiased PCR and DHPLC analysis were performed for methylation analysis at the Igf2 locus.The predictive value of the Igf2 methylation profile for HCC was assessed by Kaplan-Meier and Cox methods.RESULTS: Among 94 included patients,20 developed an HCC during follow-up (6.9±3.2 years).The methylation profile was hypomethylated,intermediate and hypermethylated in 13,64 and 17 cases,respectively.In univariate analysis,two baseline parameters were associated with the occurrence of HCC: age (P=0.01) and prothrombin (P=0.04).The test of linear tendency between the three ordered levels of Igf2 methylation and probability of HCC occurrence was significant (Log Rank,P=0.043;Breslow,P=0.037; Tarone-Ware,P=0.039).CONCLUSION: These results suggest that hypomethylation at the Igf2 locus in the liver could be predictive for HCC occurrence in HCV cirrhosis.