Screening for hepatocellular carcinoma in patients with Child's A cirrhosis: an 8-year prospective study by ultrasound and alphafetoprotein

Cottone, Mario; Turri, Marco; Caltagirone, Maria; Parisi, P.; Orlando, Ambrogio; Fiorentino, Germana; Virdone, Roberto; Fusco, G; Grasso, Rossella; Simonetti, Rosa G; Pagliaro, Luigi

doi:10.1016/s0168-8278(05)80613-0

Cited by 159 publications

(74 citation statements)

References 18 publications

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“…Finally, 17 articles were included in our study (Fig. 1, Table 1) [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84]. Eleven studies included data on more than one tumor marker [70, 71, 73-77, 79-81, 83], and 4 of them provided sensitivity and specificity of a combination of two tumor markers [70,74,77,79].…”

Section: Resultsmentioning

confidence: 99%

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Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

et al. 2007

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Background and aims The role of alphafetoprotein (AFP) in the diagnosis and surveillance of hepatocellular carcinoma (HCC) is getting smaller owing to the advances in imaging modalities. The aims of this study were to assess the diagnostic accuracy of tumor markers in small HCC and to find the optimal cutoff value of each tumor marker for efficient surveillance. Methods Studies in all languages were identified by searching MEDLINE from 1982 to 2002. Studies were included when they showed sensitivity and specificity for HCCs 5 cm or smaller and recruited only patients with chronic hepatitis or liver cirrhosis as control. We assessed diagnostic odds ratios (DORs) for the evaluation of diagnostic accuracy of tumor markers and positive likelihood ratios (LRs+) to find the optimal cutoff value. DORs and LRs+ were combined according to the random effect model. The summary receiver operating characteristics (ROC) curve was also assessed. Results Seventeen articles on three tumor markers-AFP, des-gamma-carboxyprothrombin (DCP), and Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3)-were enrolled after full-text evaluation. AFP was inferior to DCP and AFP-L3 in both DOR (4.50 vs. 8.16 and 10.50) and area under the ROC curve (0.647 vs. 0.688 and 0.695). Optimal cutoff values that provide the best LR+ were 200 ng/ml for AFP, 40 mAU/ml for DCP, and 15% for AFP-L3. Conclusions Diagnostic accuracy of AFP in small HCC was substantially limited. Surveillance including other tumor markers with optimal cutoff value should be conducted to confirm the efficacy of the policy.

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Section: Resultsmentioning

confidence: 99%

“…Approximately, 75-80% of primary liver cancers are attributable to persistent viral infections with either hepatitis B virus (HBV) or hepatitis C virus (HCV) [3][4][5][6], and the annual incidence of HCC with cirrhosis is 1-7% [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

et al. 2007

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“…Most studies adopt a cutoff value of 20 ng/mL for AFP, with a sensitivity ranging from 49 to 71% and specificity from 49 to 86% in HCCs smaller than 5 cm [146][147][148][149][150][151][152][153][154]. Limitations in the sensitivity and specificity of AFP in surveillance of high-risk populations have led to the use of US as an additional method for the detection of HCC [142,[155][156][157].…”

Section: What Modality Should Be Used?mentioning

confidence: 99%

“…Many studies have adopted an interval of 6 months between periodic diagnostic tests [155][156][157], although there are no randomized studies that have determined the optimal interval.…”

Section: Optimal Interval For Screeningmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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“…Its incidence is increasing every year because of (i) an increase in life expectancy of patients presenting cirrhosis, (ii) improved diagnosis or treatment of hepatic diseases, and (iii) a higher frequency of the hepatic pathologies connected to the hepatitis C virus. [1][2][3][4] The three curative treatments of HC are transplantation, resection and percutaneous destruction, 5 all of which improve the natural history of the HC and prolong the survival of patients with a unique tumor of less than 5 cm or a maximum of three lesions measuring at most 3 cm. In all other cases, however, these treatments become palliative.…”

Section: Introductionmentioning

confidence: 99%

Preclinical study of an ex vivo gene therapy protocol for hepatocarcinoma

Lortal

Gross²,

Péron

et al. 2008

Cancer Gene Ther

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Preclinical studies in several animal models as well as clinical trials have shown a reduction in tumor growth following immunotherapy with interleukin-12 (IL-12). This cytokine is appropriate to test in therapeutic clinical trials to treat hepatocarcinoma (HC), a pathology often associated with hepatitis B or C-induced cirrhosis. The local delivery into the liver would be achieved through ex vivo gene transfer using retroviral (rv) vectors in autologous fibroblast carriers. In support of this clinical trial, a rv vector has been constructed to express coordinately both chains p35 and p40 of human IL-12. Here, we have tested good manufacturing practices (GMP) clinical lots of viral vectors derived from the transfected packaging cell line, PG13rvIL-12. We have also devised methods to facilitate the isolation of fibroblasts from freshly harvested skin specimens, enhance their outgrowth in large-scale cultures and assay IL-12 production following transduction, without any selection and irradiation. Twentyfour human skin specimens were processed to obtain fibroblast suspensions that were typically maintained for up to 8 or 12 passages. The mean ± s.d. overall time for obtaining the required number of transduced cells for the highest IL-12 need was 40 days. The procedure, in accordance with the French medical agency for gene therapy clinical trials, is now ready to begin a clinical trial.

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Screening for hepatocellular carcinoma in patients with Child's A cirrhosis: an 8-year prospective study by ultrasound and alphafetoprotein

Cited by 159 publications

References 18 publications

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

Preclinical study of an ex vivo gene therapy protocol for hepatocarcinoma

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