Factors That Affect Efficacy of Ultrasound Surveillance for Early Stage Hepatocellular Carcinoma in Patients With Cirrhosis

Poggio, P. Del; Olmi, Stefano; Ciccarese, Francesca; Marco, Mariella Di; Rapaccini, Gian Ludovico; Benvegnù, Luisa; Borzio, Franco; Farinati, Fabio; Zoli, Marco; Giannini, Edoardo G.; Caturelli, Eugenio; Chiaramonte, M.; Trevisani, Franco

doi:10.1016/j.cgh.2014.02.025

Cited by 119 publications

(134 citation statements)

References 28 publications

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“…Ultrasound is even less likely to detect early-stage HCC in male patients and those with Child B or Child C cirrhosis. 88 Inadequate sensitivity of surveillance tools is a common reason for late-stage tumor detection among patients followed in tertiary-care centers 45 . Given that low annual incidence rate, the cost-effectiveness of HCC surveillance programs in NAFLD or NASH without cirrhosis still requires further evaluation.…”

Section: Surveillancementioning

confidence: 99%

Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice

Singal

El–Serag

2015

Clinical Gastroenterology and Hepatology

467

369

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Hepatocellular carcinoma (HCC) is the 3rd leading cause of cancer-related death worldwide and one of the leading causes of death in patients with cirrhosis.1]HCC incidence in the United States (US) has more than doubled over the past 2 decades and is anticipated to continue increasing over the next 20 y, due to the growing number of patients with advanced hepatitis C virus (HCV) and/or non-alcoholic steatohepatitis (NASH). At its current pace, HCC is projected to surpass breast and colorectal cancer to become the 3rd leading cause of cancer-related death in the US by 2030.2 Currently only 46% of HCC cases are diagnosed at an early stage and most do not receive curative therapy.2 Epidemiologic and clinical studies have identified many factors that affect risk for HCC and can be used to identify at-risk patients and implement prevention measures. Although several advances in HCC prevention, early detection, and diagnosis are efficacious and could reduce the incidence and mortality of HCC, widespread dissemination and successful implementation are essential for these strategies to be effective in clinical practice. Challenges include limited recognition of at-risk patients, availability of well-validated risk stratification measures, and surveillance in high-risk groups.

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Section: Surveillancementioning

confidence: 99%

Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice

Singal

El–Serag

2015

Clinical Gastroenterology and Hepatology

467

369

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“…Computed tomography (CT) and magnetic resonance imaging (MRI) have been widely used for HCC diagnosis, and are less affected by the limitations of ultrasound, e.g., inter-operator variation, and likely yield better performance [13, 29]. However, these modalities have been deemed unsuitable as tools for surveillance due to the high costs and irradiation (for CT) [6].…”

Section: Experimental Hcc Surveillance Modalitiesmentioning

confidence: 99%

“…Model-based simulation studies have demonstrated that biannual ultrasound for all cirrhotic patients is cost-effective compared to no surveillance, although average survival extension was less than 6 months [11]. The major limitations include suboptimal performance of the currently available surveillance modalities and the one-size-fits-all strategy recommended in the practice guidelines [12, 13], which may be substantially improved by tailored approaches discussed in this review.…”

Section: Introductionmentioning

confidence: 99%

Tailored Algorithms for Hepatocellular Carcinoma Surveillance: Is One-Size-Fits-All Strategy Outdated?

Goossens

Bian

Hoshida

2017

Curr Hepatology Rep

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Purpose of review Current clinical practice guidelines recommend regular hepatocellular carcinoma (HCC) surveillance with biannual ultrasound with or without serum alpha-fetoprotein uniformly applied to all patients with cirrhosis. However, clinical implementation of this one-size-fits-all strategy has been challenging as evidenced by very low application rate below 20% due to various reasons, including suboptimal performance of the surveillance modalities. Recent findings Newly emerging imaging techniques such as abbreviated MRI (AMRI) and molecular HCC risk biomarkers have increasingly become available for clinical evaluation and implementation. These technologies may have a potential to reshape HCC surveillance by enabling tailored strategies. This would involve performing optimized surveillance tests according to individual HCC risk, and allocating limited medical resources for HCC surveillance based on cost-effectiveness. Summary Tailored HCC surveillance could lead to achievement of precision HCC care and substantial improvement of the current dismal patient prognosis.

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“…Another contributing factor may be the effectiveness of surveillance in both Micronesians and NMPI where the mean BMI is high and about half of the patients are obese with BMI above 30. Previous studies including one from this center have demonstrated that ultrasound surveillance is less reliable in obese patients [15,16]. …”

Section: Discussionmentioning

confidence: 99%

Hepatocellular Carcinoma in Micronesians, a Growing Pacific Islander Population in the U.S.

Hernandez

2018

OJGas

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Aim: Micronesians are a rapidly growing population in Hawaii and the continental U.S. Hepatitis B is prevalent in Micronesia, but the consequences in those migrating to the U.S. are unclear. This study characterizes hepatocellular carcinoma in Micronesians with comparisons to other Pacific Islanders. Methods: A retrospective evaluation was undertaken of 40 Micronesian and 142 Non-Micronesian Pacific hepatocellular carcinoma patients diagnosed in a large clinical practice in Hawaii from 1993–2017. Results: All Micronesians were born outside of the U.S. Micronesians were younger at diagnosis (52.0 vs 60.2 years, had higher rates of hepatitis B (80% vs 31.2%), a family history of hepatocellular carcinoma (17.5% vs 4.4%) and more tumors <5 cm (64.1% vs 45.2%). Non Micronesian Pacific Islanders had higher rates of Hepatitis C (48.6% vs 22.5%) and hypertension (61.7% vs 32.4%). There was no difference in the proportions of screen-detected tumors, those meeting Milan criteria, tumor stage, or liver function. Micronesians had better 5-year survival rates (48% vs 16.7%). Conclusion: Hepatocellular carcinoma in Micronesians is primarily Hepatitis B-related. Micronesians were equally likely to have hepatocellular carcinoma found with screening, undergo transplant and had better survival. Our study emphasizes the need for hepatitis B screening and hepatocellular carcinoma surveillance in Micronesians.

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Factors That Affect Efficacy of Ultrasound Surveillance for Early Stage Hepatocellular Carcinoma in Patients With Cirrhosis

Cited by 119 publications

References 28 publications

Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice

Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice

Tailored Algorithms for Hepatocellular Carcinoma Surveillance: Is One-Size-Fits-All Strategy Outdated?

Hepatocellular Carcinoma in Micronesians, a Growing Pacific Islander Population in the U.S.

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