Surveillance for hepatocellular cancer

Abstract

high in patients with cirrhosis who develop HCC. 8 Mortality data from the UK for HCC demonstrates that this is rising in parallel with the incidence rates of HCC such that in 2015 there were approximately 1,700 deaths due to HCC. Since cirrhosis is readily identified and the risk of HCC is known, regular surveillance testing using ultrasound scanning is proposed to identify HCC early and to facilitate curative treatment.9 This rationale is supported by many international guidelines for the management of patients with cirrhosis including the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD), as well as by recent guidance issued by the National Institute for Health and Care Excellence (NICE). 10-12 However, the recommendation that patients with cirrhosis have regular surveillance for HCC is not universally accepted and the majority of patients do not receive surveillance. 13-15The imperative for surveillanceMany international authorities, including the AASLD and the EASL recommend that high risk groups are entered into surveillance programmes. This includes the majority of patients with cirrhosis but not those with advanced liver failure unless they are on the transplant waiting list. Patients with non-cirrhotic HBV infection and patients with HCV infection and advanced fibrosis (defined as fibrosis stage 3 [out of 4, where 4 is cirrhosis]) are also recommended to have surveillance due to the increased incidence of HCC in these groups. 11 Surveillance of individuals without cirrhosis will not be discussed further in this article. Surveillance relies on the ideal that if we detect early asymptomatic cancers, curative treatment options are available to these patients. These treatments include resection, transplantation and radiofrequency ablation, each of which can achieve 5-year survival rates near 70% for small lesions, <2.5 cm in diameter.9 Recurrent HCC is frequently observed after liver resection and ablation since the development of HCC is associated with the underlying cirrhosis and that cirrhosis is not treated or targeted by local therapies. Liver transplantation offers a real prospect of cure for these patients; however, in practice this option is limited in applicability due to comorbidity and limited in availability due to a shortage of donor organs. Current provision of surveillanceReports of HCC surveillance in patients with cirrhosis consistently show poor uptake and adherence to the published guidance. A UK survey confirmed these international findings and showed that current surveillance for HCC is poor, provision is ad hoc and there Hepatocellular carcinoma (HCC) is a common complication of cirrhosis. The incidence of HCC is rising and HCC-related mortality is rising in parallel such that there were more than 1,700 deaths in the UK in 2015. Since cirrhosis is a known risk factor for the development of HCC and early diagnosis is associated with improved outcomes, surveillance for the development of HCC using regular ultrasou...

Hepatocellular carcinoma in non-alcoholic fatty liver disease with and without cirrhosis

“…In addition, those with NAFLD-related HCC have a worse prognosis, since they have a shorter survival time, a more advanced tumor at diagnosis and a lower probability of liver transplantation [31,45] . This reinforces the idea that a rewording of current HCC screening recommendations is needed so that these high-risk patients can be diagnosed via routine assessment [3,5,46] . It is also understood that, because of the high prevalence of this type of liver disease, the extension of screening to this whole group would greatly increase health spending, making it less viable [47] .…”

High mobility group box 3 as an emerging biomarker in diagnosis and prognosis of hepatocellular carcinoma

“… 19 Although serum AFP has been routinely tested for HCC diagnosis, it exhibits a low sensitivity and specificity iñ40% of negative patients. 20 Circulating soluble HMGB1 was examined as a useful predictor for advanced HCC patients treated with sorafenib and hepatic arterial infusion chemotherapy. 21 However, no significant difference in serum HMGB1 level between HCC patients and healthy controls was observed in another cohort.…”

British Society of Gastroenterology Best Practice Guidance: outpatient management of cirrhosis – part 1: compensated cirrhosis

“…However, potential physical and psychosocial harms of surveillance, including false-positive testing resulting in unnecessary and risk-associated procedures such as liver biopsy must also be considered, and surveillance should be targeted to those patients who are most likely to benefit. 22 …”