Community-Based Mass Ultrasonographic Screening of Hepatocellular Carcinoma among Thrombocytopenic Adults

Abstract

Thrombocytopenia has been reported as a valid surrogate for liver cirrhosis and could be used to identify groups at high risk of hepatocellular carcinoma (HCC) for ultrasonographic (US) screening. We designed this two-stage community-based screening for HCC. In 2004, subjects (ages z40 years) were invited to undergo comprehensive health examinations, with 17,551 men (ages 63.0 F 11.5 years) and 39,151 women (ages 59.9 F 11.7 years) participating. Subjects with platelet counts <150 Â 10 9 /L or A-fetoprotein (AFP) >20 ng/mL were enrolled for the second-stage US screening; 3,242 subjects (5.7%; male/ female, 1,415/1,827; age 66 F 10 years) were candidates for US screening and 2,983 (92.2%) responded. Of 137 suspected cases, 124 (90.5%) complied with referral for confirmation and 72 (58.1%) were confirmed to be HCC cases (male/female, 41/31; age 68.1 F 8.8 years). Screening with AFP, thrombocytopenia, or both could identify 0.64% (n = 364), 5.33% (n = 3,205), and 5.7% (n = 3,242) of the high-risk subjects from the population, estimated to include 50.5%, 54.5%, and 71.3% of all HCC cases. Among confirmed patients, tumor diameters were <3 cm for the 27 (37.5%) patients and 3 to 5 cm for the 23 (31.9%) patients. Only 5 (6.9%) patients' conditions were too advanced to be actively treated. This study enrolled only 5.7% of the participants for US, which cover 64.7% to 71.3% of the HCC cases. Most (93%) of the detected cases were caught early enough to undergo effective treatment modalities. This HCC screening protocol should be feasible, economical, and effective. (Cancer Epidemiol Biomarkers Prev 2008;17(7):1813 -21)

Small Hepatocellular Carcinomas and Thrombocytopenia

“…An increase in the incidence of PVT with increased HCC size has been noted previously [23] and was a trend in our patients, as was elevated AFP levels and tumor size. We found that thrombocytopenia, which has previously been noted in association with cirrhosis and HCC [12,13,14,29,30], was significantly different between the 2 tumor-size groups and was unexpectedly more pronounced in patients with smaller tumors than in those with the larger ones.…”

Improvement of Thrombocytopenia in Hepatitis C-Related Advanced Fibrosis Patients After Sustained Virological Response

“…It has been shown that thrombocytopenia could be used to predict the development of esophageal varices [25], identify advanced fibrosis and cirrhosis in chronic HCV infection, and could also be used as a tool to identify high-risk groups of HCC [14,15,17]. The increasing (and even normalization of) platelet counts in patients with advanced fibrosis/ cirrhosis might promise less progression of liver failure and liver-related mortality [3,4], formation of esophageal varices, and HCC [3,5].…”

“…In our previous community studies, thrombocytopenia has also been used to identify advanced fibrosis and cirrhosis in patients with chronic HCV infection [14]. In addition, thrombocytopenia could also be used as a tool to identify high-risk groups of HCC [14,15].…”

Hospital- and Community-Based Screenings for Hepatocellular Carcinoma in Taiwan

“…Half of the county governments have also provided hepatitis screening programs [4,5,20,21]. Nationwide or local foundations [22,23] have conducted screening programs.…”

“…The next model of community-based screening was conducted in dual HBV- and HCV-endemic areas (model 4) [20]. AFP was shifted from the second stage to the first stage.…”