Improved survival with screening for hepatocellular carcinoma

Wong, Linda L.; Limm, Whitney; Severino, Ricardo; Wong, Livingston

doi:10.1053/lv.2000.4875

Cited by 124 publications

(76 citation statements)

References 17 publications

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“…Similarly, Farinati and Gianni [20], in a study of 280 Italian patients, showed that patients in whom HCC was diagnosed by screening had an earlier tumor staging than unscreened patients, resulting in a mean gain in survival of 16 months even after adding 10 months to the survival for the unscreened patients. Observational studies suggest that HCCs detected during surveillance were smaller and hence more likely to be a solitary lesion than those that present symptomatically or incidentally [21,22]. Surveillance would improve the opportunity for early detection of HCC, consequently, HCC patients whose disease is detected as a result of surveillance are more likely to receive curative treatment.…”

Section: Discussionmentioning

confidence: 99%

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Effect of surveillance for hepatocellular carcinoma on tumor staging and treatment decisions in Egyptian patients

et al. 2010

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Purpose Egyptian hepatocellular carcinoma (HCC) patients present at advanced stages. We aimed to study the influence of surveillance versus non-surveillance on HCC staging and the potential therapeutic options. Methods A retrospective study to evaluate the effect of surveillance on early detection of HCC among cirrhotic patients from 2003 to 2008. Patients examined every 6 months using ultrasound and a-fetoprotein (a-FP) (group A) and those diagnosed with those that present for the first time symptomatically or incidentally (group B). Groups were compared for a-FP level, tumour characteristics, severity of liver disease; tumour staging was evaluated by Okuda, CLIP and BCLC staging systems, in addition to the potential therapeutic options. Results Group A comprised 122 HCC cases and group B 473. Surveillance improved HCC detection: at the stage of single nodule in 62.3% in group A versus 52.2% in group B, (P = 0.046) and reduced the percentage of HCC with portal vein thrombosis in 16.4 versus 33.8%, (P = 0.000) and the percentage of a-FP [400 ng/ml in 19.5 versus 32.6%, (P = 0.006) in groups A and B, respectively. Surveillance doubled the detection of HCC at early stage of BCLC (25.4 vs. 11.9% P = 0.000) and doubled the patients' chance for loco-regional ablation (12.3 vs. 5.9%, P = 0.015) and liver transplantation (10.7 vs. 3.2%, P = 0.001) in groups A and B, respectively. Conclusion HCC surveillance increases early detection of HCC and doubled the chances for curative options. Implementation of both HCC surveillance and cadaveric liver transplantation programs should be recommended in Egypt.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, the current available data seem to indicate that implementing screening programs improves the outcome for patients in terms of increasing the chance of successful treatment and prolonging survival [20,21,24,32]. In countries where HCC is of low prevalence, screening for HCC may not be cost-effective.…”

Section: Discussionmentioning

confidence: 99%

Effect of surveillance for hepatocellular carcinoma on tumor staging and treatment decisions in Egyptian patients

et al. 2010

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“…In a population with cirrhosis, the most common clinical sequela is HCC (3). The early detection of HCC markedly improves outcome (4). While the risk factors for patients at the highest risk for developing HCC are well characterized, the early detection of liver cancer remains a challenge.…”

Section: Introductionmentioning

confidence: 99%

Serum levels of soluble CD25 as a marker for hepatocellular carcinoma

et al. 2012

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Abstract. In a previous study, we showed that the level of soluble CD25 (sCD25) was elevated in a small series of patients with hepatocellular carcinoma (HCC). In the present study, we determined the capacity of serum levels of sCD25 to detect the presence and the early stage of HCC using a larger cohort of HCC patients and evaluated the correlation between sCD25 level and tumor burden. Serum levels of sCD25 were quantified using ELISA in patients with HCC (n=145), controls with advanced fibrosis (n=61) and healthy control subjects (n=30). The levels of sCD25 in patients with HCC (median, 6,955 pg/ml) were significantly higher than those in cirrhosis-only patients (4,310 pg/ml; P<0.0001). At a cut-off value of 2,180 pg/ml, sCD25 had a sensitivity of 92.3% and a specificity of 37.7% in detecting HCC presence [area under the curve (AUC) of 0.685; P<0.0001]. By comparison, α-fetoprotein (AFP) had a sensitivity of 53.8% and a specificity of 86.8% at a cut-off value of 32.8 ng/ml (AUC=0.755; P<0.0001) for HCC presence detection. For early HCC, the sensitivity of sCD25 was 89.6% and its specificity was 39.3% (AUC=0.630; P<0.0001) at a cut-off value of 2,859 pg/ml, while AFP had a sensitivity of 41.7% and a specificity of 82.6% at a cut-off value of 20.6 ng/ml (AUC=0.630; P=0.0257). We also found a significant positive correlation between serum levels of sCD25 and tumor stage. In the present study study, sCD25 was more effective than AFP at detecting the presence and early stages of HCC. This immune factor may hold promise as a novel predictive marker of HCC presence and may be useful in distinguishing early HCC from advanced cirrhosis, currently areas of global unmet need.

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“…Many symptomatic HCCs are diagnosed in advanced stage and cannot be treated, so the prognosis is generally poor (Wong et al, 2000;Bruix and Llovet, 2002). By the accumulation of knowledge of the risk factors and the prevalence of HCC surveillance, the proportion of HCC diagnosed in early stage and that can be treated by local ablation therapies or surgery has increased (Bolondi, 2003;Adams et al, 2004;Trevisani et al, 2004).…”

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confidence: 99%

Prognostic factors and treatment effects for hepatocellular carcinoma in Child C cirrhosis

Nouso¹,

Ito

Kuwaki

et al. 2008

Br J Cancer

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The aim of this study is to elucidate the prognostic factors and the treatment effect on survival in hepatocellular carcinoma (HCC) patients with Child C cirrhosis. Out of 3330 newly discovered HCC patients, 157 consecutive HCC individuals with Child C cirrhosis were enrolled. The prognostic factors were examined by Cox proportional hazards regression analysis and their survival was compared by propensity score-matched analysis. Multivariate analysis revealed that high serum bilirubin (43 mg dl À1 ), the presence of uncontrollable ascites, and a high platelet count (48 Â 10 4 mm À3 ), so-called background liver factors, as well as multiple tumours, large tumours (43 cm), high alpha-fetoprotein (4400 ng ml À1 ), and the presence of portal vein thrombus, so-called tumour factors, were factors of poor prognosis. While transcatheter arterial chemoembolisation (TACE) was a factor of good prognosis (relative risk ¼ 0.50, 95%CI ¼ 0.27 -0.89, P ¼ 0.019), local ablation therapy and transcatheter arterial chemoinfusion (TAI) were not significant prognostic factors. The survival of patients who received TACE was superior to matched patients without active treatment (P ¼ 0.009); however, we did not observe survival benefit after local ablation therapy or TAI. These results suggested that tumour factors as well as background liver factors are prognostic factors of HCC even in patients with Child C cirrhosis, and selective use of TACE in these patients provides survival benefit.

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Improved survival with screening for hepatocellular carcinoma

Cited by 124 publications

References 17 publications

Effect of surveillance for hepatocellular carcinoma on tumor staging and treatment decisions in Egyptian patients

Effect of surveillance for hepatocellular carcinoma on tumor staging and treatment decisions in Egyptian patients

Serum levels of soluble CD25 as a marker for hepatocellular carcinoma

Prognostic factors and treatment effects for hepatocellular carcinoma in Child C cirrhosis

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