| | Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survivalReceived 21 December 2009; received in revised form 12 March 2010; accepted 16 March 2010. published online 05 May 2010. Background & AimsThe current guidelines recommend the surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on liver ultrasonography repetition at either 6 or 12 month intervals, since there is no compelling evidence of superiority of the more stringent program. This study aimed at comparing cancer stage, treatment applicability, and survival between patients on semiannual or annual surveillance. MethodsWe analyzed the clinical records of 649 HCC patients in Child-Pugh class A or B, observed in ITA.LI.CA centers. HCC was detected in 510 patients submitted to semiannual surveillance (Group 1) and in 139 submitted to annual surveillance (Group 2). In Group 1 the survival was presented as observed and corrected for the lead time. ConclusionsSemiannual surveillance increases the detection rate of very early hepatocellular carcinomas and reduces the number of advanced tumors as compared to the annual program. This translates into a greater applicability of effective treatments and into a better prognosis. Abbreviations: HCC, hepatocellular carcinoma, HBsAg, hepatitis B surface antigen, US, ultrasonographies, AASLD, American Association of the Study of the Liver Disease, C-P, Child-Pugh, ITA.LI.CA, Italian Liver Cancer, AFP, α-fetoprotein, HCV, hepatitis C virus, HBV, hepatitis B virus, CT, computed tomography, MRI, magnetic resonance imaging, CEUS, contrast enhanced–US, V0, without macrovascular invasion, L0, without lymph-node invasion, M0, without distant metastases, PEI, percutaneous ethanol injection, RF, radiofrequency thermoablation, TACE, transarterial chemoembolization, ALT, alanine aminotranspherase, CI, confidence interval, DT, doubling time, OLT, orthotopic liver transplantation 1 Dipartimento di Medicina Clinica, Unità di Semeiotica Medica, Alma Mater Studiorum – Università di Bologna, Italy 2 Divisione di Medicina, Ospedale Treviglio-Caravaggio, Treviglio, Italy 3 Divisione di Medicina, Azienda Ospedaliera Bolognini, Seriate, Italy 4 Dipartimento di Medicina Clinica e Sperimentale, Unità di Medicina, Università di Padova, Italy 5 Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Unità di Gastroenterologia, Università di Padova, Italy 6 Dipartimento di Medicina Clinica, Unità di Medicina, Alma Mater Studiorum – Università di Bologna, Italy 7 Dipartimento di Medicina Interna, Unità di Gastroenterologia, Università di Genova, Italy 8 Dipartimento di Medicina, Unità di Medicina Interna ed Epatologia, Ospedale Fatebenefratelli, Milano, Italy 9 Unità di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy 10 Unità di Gastroenterologia, Ospedale Sacro Cuore Don Calabria, Negrar, Italy  Corresponding author. Address: Dipartimento di Medicina Clinica, Semeiotica Medica, via Albertoni, 15, 40138 Bologna, Italy. Tel.: +39 051 6362923; fax: +39 051 6362930.
PII: S0168-8278(10)00327-2 doi:10.1016/j.jhep.2010.03.010 © 2010 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved. | |
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