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Surveillance for Early Diagnosis of Hepatocellular Carcinoma: Is It Effective in Intermediate/Advanced Cirrhosis?
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Journal Article
Surveillance for Early Diagnosis of Hepatocellular Carcinoma: Is It Effective in Intermediate/Advanced Cirrhosis?
2007
Overview
Surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on ultrasonography and alpha-fetoprotein (AFP) measurement, is widely used. Its effectiveness depends on liver function, which affects the feasibility of treatments and cirrhosis-related mortality. We assessed whether patients with intermediate/advanced cirrhosis benefit from surveillance.
We selected 468 Child-Pugh class B and 140 class C patients from the ITA.LI.CA database, including 1,834 HCC patients diagnosed from January 1987 to December 2004. HCC was detected in 252 patients during surveillance (semiannual 172, annual 80 patients; group 1) and in 356 patients outside surveillance (group 2). Survival of surveyed patients was corrected for the estimated lead time.
Child-Pugh class B: cancer stage (P < 0.001) and treatment distribution (P < 0.001) were better in group 1 than in group 2. The median (95% CI) survivals were 17.1 (13.5-20.6) versus 12.0 (9.4-14.6) months and the survival rates at 1, 3, and 5 yr were 60.4%versus 49.2%, 26.1%versus 16.1%, and 10.7%versus 4.3%, respectively (P= 0.022). AFP, gross pathology, and treatment of HCC were independent prognostic factors. Child-Pugh class C: cancer stage (P= 0.001) and treatment distribution (P= 0.021) were better in group 1 than in group 2. Nonetheless, median survival did not differ: 7.1 (2.1-12.1) versus 6.0 (4.1-7.9) months (P= 0.740).
These results suggest surveillance be offered to class B patients and maintained for class A patients who migrate to the subsequent class. Surveillance becomes pointless in class C patients probably because the poor liver function adversely affects the overall mortality and HCC treatments.
Publisher
Blackwell Publishing,Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Subject
/ alpha-Fetoproteins - analysis
/ Biological and medical sciences
/ Biomarkers, Tumor - analysis
/ Carcinoma, Hepatocellular - diagnostic imaging
/ Carcinoma, Hepatocellular - epidemiology
/ Carcinoma, Hepatocellular - pathology
/ Carcinoma, Hepatocellular: ultrasonography
/ Female
/ Gastroenterology. Liver. Pancreas. Abdomen
/ Humans
/ Liver Cirrhosis - complications
/ Liver Cirrhosis - diagnostic imaging
/ Liver Cirrhosis - epidemiology
/ Liver Cirrhosis: ultrasonography
/ Liver Neoplasms - diagnostic imaging
/ Liver Neoplasms - epidemiology
/ Liver Neoplasms: ultrasonography
/ Liver. Biliary tract. Portal circulation. Exocrine pancreas
/ Male
/ Tumor Markers, Biological: analysis
/ Tumors
