Screening for hepatocellular carcinoma: summary of current guidelines up to 2018

Yılmaz, Nevin; Yilmaz, Uğur; Süer, Kaya; Göral, Vedat; Çakir, Nedim

doi:10.20517/2394-5079.2018.49

Cited by 23 publications

(13 citation statements)

References 34 publications

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“…Clinical and laboratory data were collected before the initiation of antiviral treatment until the last visit at 6‐monthly intervals of follow‐up, according to a standardized protocol. All patients had virological, haematological and biochemical laboratory testing, abdominal ultrasound examination, FibroScan and triphasic MSCT if indicated 8 . The follow‐up duration was calculated as the time between the end of treatment and the last follow‐up, or the date of event development (HCC occurrence), whichever occurred first.…”

Section: Methodsmentioning

confidence: 99%

Development of a simple dynamic algorithm for individualized hepatocellular carcinoma risk‐based surveillance using pre‐ and post‐treatment general evaluation score

Shiha

Soliman

Mikhail

et al. 2021

Liver International

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Background and Aims With the growing number of treated hepatitis C patients, the current ‘one‐size‐fits‐all’ hepatocellular carcinoma (HCC) surveillance strategies for patients with advanced fibrosis represents a great burden on healthcare systems. An individualized HCC risk strategy incorporates the dynamic changes of HCC risk are lacking. Methods This single‐centre observational study included 3075 patients, with advanced fibrosis (≥F3) who achieved SVR following DAAs at Egyptian Liver research institute and hospital (ELRIAH) with follow‐up period (range 6‐72 months). The performance of a recently developed General Evaluation Score (GES) HCC risk stratification score was calculated pre‐ and post‐treatment using Harrell’s c statistic. Times to HCC and cumulative incidences were calculated with Kaplan–Meier method and compared using log‐rank (Mantel‐Cox) test. Results Pre‐treatment GES score stratified patients into low (60.4%), intermediate (23.4%), and (16.2%) high‐risk score where 5‐year cumulative incidences of HCC were 1.66%, 4.45% and 7.64%, respectively. Harrell’s c statistic was 0.801. Post‐treatment GES score stratified patients into low (57.4%), intermediate (30.7%) and (11.9%) high‐risk score where 5‐year cumulative incidences of HCC were 1.35%, 3.49% and 11.09% respectively. The cumulative HCC incidence increased significantly with higher scores (P < .001). Harrell's c statistic was 0.818. Using pre‐ and post‐treatment GES score, GES algorithm was developed with higher predictive value. The cumulative HCC incidence increased significantly with higher scores (P < .001). Harrell’s c statistic was 0.832. Conclusion A dynamic algorithm incorporating both pre‐ and post‐GES scores have better performance and predictive value compared with only pre‐treatment assessments. The proposed algorithm would help to stratify those who need intensive or being excluded from screening.

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Section: Methodsmentioning

confidence: 99%

Development of a simple dynamic algorithm for individualized hepatocellular carcinoma risk‐based surveillance using pre‐ and post‐treatment general evaluation score

Shiha

Soliman

Mikhail

et al. 2021

Liver International

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“…Due to this patient's poor liver function and advanced staging of HCC, she had no options available to her except Sorafenib, a second-line multikinase inhibitor proven to prolong survival by one to three months, which she denied [19]. [10,20].…”

Section: Evaluating Liver Function and Cirrhosis Severity When Electing Screening And Treatment Options For Hccmentioning

confidence: 99%

Hepatocellular Carcinoma With Tumor Thrombus to the Hepatic Veins and the Right Atrium: A Case Report and Review Exploring Various Presentations and Treatment Options

Wassef

2020

Cureus

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Hepatocellular carcinoma (HCC) is a leading cause of cancer and cancer-related deaths in the world. Some of the risk factors for the development of HCC include Hepatitis B virus (HBV), Hepatitis C virus (HCV), chronic alcoholism, autoimmune hepatitis, among others. One manifestation of HCC includes tumor thrombus (TT) to the right atrium (RA), which occurs in 0.67-4.1% of patients with HCC. Our case focuses on a unique presentation of HCC with RA TT with initial symptoms of nausea and vomiting without signs of cardiac decompensation or hemodynamic instability. Although there is no definitive treatment for TT to the RA, there are a variety of proven avenues of management of HCC TT to the RA, especially pertaining to patients with adequate liver function.A 63-year old female with a past medical history of untreated HCV and alcohol abuse with no previously known liver disease or history of liver decompensation, presented with nausea, vomiting, and diarrhea. Initial labs revealed hypovolemic hyponatremia and transaminitis with negative ethanol levels. The model for end-stage liver disease (MELD-Na) score was calculated at 27, and she had a Child-Pugh class C score. Follow up labs were significant for elevated alpha-fetoprotein (AFP). Triple-phase CT of the liver revealed a large liver mass with extension into the RA with TT and necrosis of the liver. An echocardiogram revealed a RA mass versus thrombus. Throughout her hospitalization, she never admitted to cardiac symptoms, including shortness of breath, palpitations, or chest pain. No tachycardia was noted, and her blood pressure remained stable. She was not a candidate for surgery or chemotherapy. The patient declined any heroic measures, and palliative care was consulted for further management. She was transferred to hospice, where she died one week later.There are numerous etiologies and clinical presentations of HCC with TT to the RA. Its disease course is insidious and may not present as symptomatic until there is a sizable tumor burden. Therefore, treatment options for HCC with TT to the RA are reliant on HCC screening for at-risk populations, early diagnosis, and each individual patient's baseline liver function.

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“…However, HBsAg and HBV DNA should be periodically rechecked (3‐6 monthly with a low threshold for re‐testing) in order to detect reactivation. If HBV is detected consider treating to render the DNA undetectable to render HBV viral load undetectable and NA therapy can be used if necessary, to achieve this and the patient should undergo ultrasound with or without alpha fetoprotein for HCC screening periodically 29 . Reactivation is more likely if patients are immunosuppressed and notably drugs such as corticosteroids, anti‐CD20 agents and others are a particular risk.…”

Section: Diagnostic Role Of Hbv Dnamentioning

confidence: 99%

Hepatitis B related dilemmas in the renal unit

2020

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Testing for hepatitis B in dialysis patients is routine, but newer and more sensitive detection methods mean that there is sometimes confusion around viral loads and occult infection. There are frequently difficult choices surrounding isolation and treatment. Here we describe the use of HBV serology and DNA testing in decisions around patients with end‐stage renal disease. We also suggest isolation decisions based on our current understanding of the virus and its infectivity.

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Screening for hepatocellular carcinoma: summary of current guidelines up to 2018

Cited by 23 publications

References 34 publications

Development of a simple dynamic algorithm for individualized hepatocellular carcinoma risk‐based surveillance using pre‐ and post‐treatment general evaluation score

Development of a simple dynamic algorithm for individualized hepatocellular carcinoma risk‐based surveillance using pre‐ and post‐treatment general evaluation score

Hepatocellular Carcinoma With Tumor Thrombus to the Hepatic Veins and the Right Atrium: A Case Report and Review Exploring Various Presentations and Treatment Options

Hepatitis B related dilemmas in the renal unit

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