Abstract
Purpose
This study evaluated the usefulness of regular check-ups by ultrasonography and contrast-enhanced imaging for early detection of hepatocellular carcinoma (HCC) in a retrospective analysis.
Patients and methods
From April 2001 to March 2007, 240 consecutive patients with HCC who were infected with hepatitis C virus (HCV) were divided into three groups. Patients diagnosed with HCC by repeated imaging constituted Group A (surveillance group). Group B comprised patients in whom HCC was detected during scheduled doctor visits for liver disease or other diseases such as diabetes. Group C comprised non-screened patients.
Results
The prevalence of solitary tumors decreased from Group A through Group B to Group C (66, 48 and 24%, respectively, P < 0.001). The proportion of patients in stages I and II decreased from 83% (103/124) in Group A to 53% (42/79) in Group B and 24% (9/37) in Group C (P < 0.001). The proportion of patients who were treated with curative procedures, such as resection or ablation, was highest at 80% (99/124) in Group A, and lower at 53% (42/79) in Group B and 27% (10/37) in Group C (P < 0.001). The cumulative survival rate was better in Group A than B (P < 0.05), and in Group B than C (P < 0.001). Periodical medical check-ups without imaging did not necessarily detect early-stage disease, even when HCC-related markers including des-γ-carboxy prothrombin were tested.
Conclusions
Regular surveillance with ultrasonography and contrast-enhanced imaging is useful for detecting early-stage HCC and increase chances for curative treatments in patients with HCV-related chronic liver disease.
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References
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.
Oka H, Kurioka N, Kim K, Kanno T, Kuroki T, Mizoguchi Y, et al. Prospective study of early detection of hepatocellular carcinoma in patients with cirrhosis. Hepatology. 1990;12:680–7.
Colombo M, de Franchis R, Del Ninno E, Sangiovanni A, De Fazio C, Tommasini M, et al. Hepatocellular carcinoma in Italian patients with cirrhosis. N Engl J Med. 1991;325:675–80.
Yuen MF, Cheng CC, Lauder IJ, Lam SK, Ooi CG, Lai CL. Early detection of hepatocellular carcinoma increases the chance of treatment: Hong Kong experience. Hepatology. 2000;31:330–5.
Tong MJ, Blatt LM, Kao VW. Surveillance for hepatocellular carcinoma in patients with chronic viral hepatitis in the United States of America. J Gastroenterol Hepatol. 2001;16:553–9.
Trevisani F, De NS, Rapaccini G, Farinati F, Benvegnù L, Zoli M, et al. Semiannual and annual surveillance of cirrhotic patients for hepatocellular carcinoma: effects on cancer stage and patient survival (Italian experience). Am J Gastroenterol. 2002;97:734–44.
Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol. 2004;130:417–22.
Yu EW, Chie WC, Chen TH. Does screening or surveillance for primary hepatocellular carcinoma with ultrasonography improve the prognosis of patients? Cancer J. 2004;10:317–25.
Mok TS, Yeo W, Yu S, Lai P, Chan HL, Chan AT, et al. An intensive surveillance program detected a high incidence of hepatocellular carcinoma among hepatitis B virus carriers with abnormal alpha-fetoprotein levels or abdominal ultrasonography results. J Clin Oncol. 2005;23:8041–7.
Trevisani F, Santi V, Gramenzi A, Di Nolfo MA, Del Poggio P, Benvegnù L, et al. Italian Liver Cancer group. Surveillance for early diagnosis of hepatocellular carcinoma: is it effective in intermediate/advanced cirrhosis? Am J Gastroenterol. 2007;102:2448–57.
Davila JA, Weston A, Smalley W, El-Serag HB. Utilization of screening for hepatocellular carcinoma in the United States. J Clin Gastroenterol. 2007;41:777–82.
Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35:421–30.
Llovet JM, Beaugrand M. Hepatocellular carcinoma: present status and future prospects. J Hepatol. 2003;38:S136–49.
Bruix J, Sherman M, Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–36.
El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132:2557–76.
Ikai I, Arii S, Ichida T, Okita K, Omata M, Kojiro M, et al. Report of the 16th follow-up survey of primary liver cancer. Hepatol Res. 2005;32:163–72.
Ohishi W, Kitamoto M, Aikata H, Kamada K, Kawakami Y, Ishihara H, et al. Impact of aging on the development of hepatocellular carcinoma in patients with hepatitis C virus infection in Japan. Scand J Gastroenterol. 2003;38:894–900.
Ikeda K, Saitoh S, Kobayashi M, Suzuki Y, Tsubota A, Suzuki F, et al. Distinction between chronic hepatitis and liver cirrhosis in patients with hepatitis C virus infection. Practical discriminant function using common laboratory data. Hepatol Res. 2000;18:252–66.
Liver Cancer Study Group of Japan. General rules for the clinical and pathological study of primary liver cancer. 2nd English ed. Tokyo: Kanehara; 2003.
Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9.
Schwartz M, Roayaie S, Konstadoulakis M. Strategies for the management of hepatocellular carcinoma. Nat Clin Pract Oncol. 2007;4:424–32. Review.
Kamada K, Kitamoto M, Aikata H, Kawakami Y, Kono H, Imamura M, et al. Combination of transcatheter arterial chemoembolization using cisplatin-lipiodol suspension and percutaneous ethanol injection for treatment of advanced small hepatocellular carcinoma. Am J Surg. 2002;184:284–90.
Kitamoto M, Imagawa M, Yamada H, Watanabe C, Sumioka M, Satoh O, et al. Radiofrequency ablation in the treatment of small hepatocellular carcinomas: comparison of the radiofrequency effect with and without chemoembolization. AJR Am J Roentgenol. 2003;181:997–1003.
Kamada K, Nakanishi T, Kitamoto M, Aikata H, Kawakami Y, Ito K, et al. Long-term prognosis of patients undergoing transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: comparison of cisplatin lipiodol suspension and doxorubicin hydrochloride emulsion. J Vasc Interv Radiol. 2001;12:847–54.
Makuuchi M, Kokudo N, Arii S, Futagawa S, Kaneko S, Kawasaki S, et al. Development of evidence-based clinical guidelines for the diagnosis and treatment of hepatocellular carcinoma in Japan. Hepatol Res. 2008;38:37–51.
Group formed to establish “Guidelines for evidence-based clinical practice for the treatment of liver cancer”. Clinical practice guidelines for hepatocellular carcinoma (in Japanese). Tokyo: Kanehara & Co., Ltd.; 2005.
Takayasu K. Hepatic angiography. In: Okuda K, Tabor E, editors. Liver cancer. New York: Churchill Livingstone; 1997. p. 347–59.
Nakashima Y, Nakashima O, Hsia CC, Kojiro M, Tabor E. Vascularization of small hepatocellular carcinomas: correlation with differentiation. Liver. 1999;19:12–8.
Kojiro M, Nakashima O. Histopathologic evaluation of hepatocellular carcinoma with special reference to small early stage tumors. Semin Liver Dis. 1999;19:287–96.
Forner A, Vilana R, Ayuso C, Bianchi L, Solé M, Ayuso JR, et al. Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma. Hepatology. 2008;47:97–104.
Adami HO, Chow WH, Nyrén O, Berne C, Linet MS, Ekbom A, et al. Excess risk of primary liver cancer in patients with diabetes mellitus. J Natl Cancer Inst. 1996;88:1472–7.
El-Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology. 2004;126:460–8.
El-Serag HB, Hampel H, Javadi F. The association between diabetes and hepatocellular carcinoma: a systematic review of epidemiologic evidence. Clin Gastroenterol Hepatol. 2006;4:369–80.
Sanyal AJ, Banas C, Sargeant C, Luketic VA, Sterling RK, Stravitz RT, et al. Similarities and differences in outcomes of cirrhosis due to nonalcoholic steatohepatitis and hepatitis C. Hepatology. 2006;43:682–9.
Ohishi W, Fujiwara S, Cologne JB, Suzuki G, Akahoshi M, Nishi N, et al. Risk factors for hepatocellular carcinoma in Japanese population: a nested case-control study. Cancer Epidemiol Biomarkers Prev. 2008;17:846–54.
Miki D, Aikata H, Uka K, Saneto H, Kawaoka T, Azakami T, et al. Clinicopathological features of elderly patients with hepatitis C virus-related hepatocellular carcinoma. J Gastroenterol. 2008;43:550–7.
Saneto H, Kobayashi M, Kawamura Y, Yatsuji H, Sezaki H, Hosaka T, et al. Clinicopathological features, background liver disease, and survival analysis of HCV-positive patients with hepatocellular carcinoma: differences between young and elderly patients. J Gastroenterol. 2008;43:975–81.
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Noda, I., Kitamoto, M., Nakahara, H. et al. Regular surveillance by imaging for early detection and better prognosis of hepatocellular carcinoma in patients infected with hepatitis C virus. J Gastroenterol 45, 105–112 (2010). https://doi.org/10.1007/s00535-009-0131-x
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DOI: https://doi.org/10.1007/s00535-009-0131-x