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Hepatocellular Carcinoma Surveillance in a Western Population with Hepatitis B

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Abstract

Hepatocellular carcinoma (HCC) is a malignant tumor arising primarily in cirrhotic livers as a consequence of chronic hepatitis B or C virus infection or alcohol-induced cirrhosis. Unlike the majority of other common cancer types, the incidence of HCC in the United States is still rising, with peak incidence expected for 2020. Although hepatitis B is a less common etiology for the development of HCC in the West, it is the most common risk factor among certain ethnic groups in the United States. Given the high case fatality of HCC, surveillance efforts have been recommended. Specifically, HCC surveillance has demonstrated a survival benefit in patients with chronic hepatitis B. In this review, we discuss the demographics of patients with HCC in the United States, the evidence promoting surveillance, and recent literature identifying the best surveillance test.

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References

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  1. American Cancer Society: Global Cancer Facts and Figures 2007. Available at http://our.cancer.org/downloads/STT/Global_Cancer_Facts_and_Figures_2007_rev.pdf. Accessed January 2011.

  2. El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132:2557–76.

    Article  PubMed  CAS  Google Scholar 

  3. American Cancer Society: Estimated New Cancer Cases and Deaths by Sex for All Sites, US, 2010. Available at http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-026210.pdf. Accessed January 2011.

  4. Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States From 1975 to 2005. J Clin Oncol. 2009;27(9):1485–91.

    Article  PubMed  Google Scholar 

  5. Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet. 2003;362:1907–17.

    Article  PubMed  Google Scholar 

  6. Di Bisceglie AM. Hepatitis B and hepatocellular carcinoma. Hepatology. 2009;49(5):S56–60.

    Article  PubMed  Google Scholar 

  7. Llovet JM, Beaugrand M. Hepatocellular carcinoma: present status and future prospects. J Hepatol. 2003;38 Suppl 1:S136–49.

    Article  PubMed  Google Scholar 

  8. McClune AC, Tong MJ. Chronic hepatitis B and hepatocellular carcinoma. Clin Liver Dis. 2010;14:461–76.

    Article  PubMed  Google Scholar 

  9. Wasley A, Kruszon-Moran D, Kuhnert W, et al. The prevalence of hepatitis B virus infection in the United States in the era of vaccination. J Infect Dis. 2010;202(2):192–201.

    Article  PubMed  Google Scholar 

  10. Barazani Y, Hiatt JR, Tong MJ, Busuttil RW. Chronic viral hepatitis and hepatocellular carcinoma. World J Surg. 2007;31:1243–8.

    Article  PubMed  Google Scholar 

  11. Beasley RP, Hwang LY, Lin CC, Chien CS. Hepatocellular carcinoma and hepatitis B virus: a prospective study of 22,707 men in Taiwan. Lancet. 1981;2:1129–33.

    Article  PubMed  CAS  Google Scholar 

  12. Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118:3030–44.

    Article  PubMed  CAS  Google Scholar 

  13. Di Bisceglie AM, Lyra AC, Schwartz M, et al. Hepatitis C-related hepatocellular carcinoma in the United States: influence of ethnic status. Am J Gastroenterol. 2003;98:2060–3.

    Article  PubMed  Google Scholar 

  14. Chen C-J, Yang H-I, Su J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295(1):65–73.

    Article  PubMed  CAS  Google Scholar 

  15. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693–9.

    Article  PubMed  CAS  Google Scholar 

  16. Zhang B-H, Yang B-H, Tang Z-Y. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol. 2004;130:417–22.

    PubMed  Google Scholar 

  17. Wong GL-H, Wong VW-S, Tan G-M, et al. Surveillance programme for hepatocellular carcinoma improves the survival of patients with chronic viral hepatitis. Liver Int. 2008;28(1):79–87.

    Article  PubMed  CAS  Google Scholar 

  18. •• Tong MJ, Sun H-E, Hsien C, Lu D: Surveillance for hepatocellular carcinoma improves survival in Asian-American patients with hepatitis B: results from a community-based clinic. Dig Dis Sci 2010, 55:826–835. This was the first US study of Asian Americans in a community-based practice that demonstrated survival benefit with HCC surveillance. Surveillance identified patients with smaller tumors and better preserved liver function.

    Article  PubMed  Google Scholar 

  19. Gupta S, Bent S, Kohlwes J. Test characteristics of alpha-fetoprotein for detecting hepatocellular carcinoma in patients with hepatitis C. A systematic review and critical analysis. Ann Intern Med. 2003;139:46–50.

    PubMed  CAS  Google Scholar 

  20. Trevisani F, D’Intino PE, Morselli-Labate AM, et al. Serum alpha-fetoprotein for diagnosis of hepatocellular carcinoma in patients with chronic liver disease: influence of HBsAg and anti-HCV status. J Hepatol. 2001;34:570–5.

    Article  PubMed  CAS  Google Scholar 

  21. • Marrero JA, Feng Z, Wang Y, et al.: Alpha-fetoprotein, Des-gamma carboxyprothrombin, and Lectin-Bound alpha-fetoprotein in Early Hepatocellular Carcinoma. Gastroenterology 2009, 137:110–118.Serum AFP was more sensitive than des-γ carboxyprothrombin and lectin-bound α-fetoprotein for diagnosing early-stage HCC.

    Article  PubMed  CAS  Google Scholar 

  22. Bolondi L, Sofia S, Siringo S, et al. Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut. 2001;48:251–9.

    Article  PubMed  CAS  Google Scholar 

  23. Paul SB, Gulati MS, Sreenivas V, et al. Evaluating patients with cirrhosis for hepatocellular carcinoma: value of clinical symptomatology, imaging and alpha-fetoprotein. Oncology. 2007;72 suppl 1:117–23.

    Article  PubMed  Google Scholar 

  24. •• Andersson KL, Salomon JA, Goldie SJ, Chung RT: Cost effectiveness of alternative surveillance strategies for hepatocellular carcinoma in patients with cirrhosis. Clinical Gastroenterology and Hepatology 2008, 6:1418–1424. Annual surveillance with CT scanning exceeded $50,000/QALY.

    Article  PubMed  Google Scholar 

  25. Lin OS, Keefe EB, Sanders GD, Owens DK. Cost-effectiveness of screening for hepatocellular carcinoma in patients with cirrhosis due to chronic hepatitis C. Aliment Pharmacol Ther. 2004;19(11):1159–72.

    Article  PubMed  CAS  Google Scholar 

  26. Zhang B, Yang B. Combined alpha-fetoprotein testing and ultrasonography as a screening test for primary liver cancer. J Med Screen. 1999;6:108–10.

    PubMed  CAS  Google Scholar 

  27. •• Santi V, Trevisani F, Gramenzi A, et al.: Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survival. Journal of Hepatology 2010, 53:291–297. Survival and ability to successfully treat HCC was higher in the group of patients surveyed semiannually. The median observed survival in patients undergoing semiannual surveillance was 45 months versus 30 months in the annual surveillance group (P = 0.001).

    Article  PubMed  Google Scholar 

  28. Mok TS, Yeo W, Yu S, et al. An intensive surveillance program detected a high incidence of hepatocellular carcinoma among hepatitis B virus carriers with abnormal alpha-fetoprotein levels of abdominal ultrasonography results. J Clin Oncol. 2005;23(31):8041–7.

    Article  PubMed  Google Scholar 

  29. •• Bruix J, Sherman M. AASLD Practice Guideline. Management of Hepatocellular Carcinoma: An Update. Hepatology 2010:1–35.Previous AASLD HCC surveillance guidelines (2005) stated that surveillance with ultrasound should be performed every 6 to 12 months. New guidelines endorse 6-month surveillance intervals.

  30. •• Chen J-D, Yang H-I, Iloeje UH, et al.: Carriers of inactive hepatitis B are still at risk for hepatocellular carcinoma and liver-related death. Gastroenterology 2010, 138:1747–1754.Inactive hepatitis B carriers (seronegative for hepatitis B e antigen, serum HBV DNA levels <10,000 copies/mL, ALT <45U/L) demonstrated a substantial risk for hepatocellular carcinoma (incidence of 0.06%/y) compared with non–HBV-infected individuals (incidence of 0.02%/y).

    Article  PubMed  Google Scholar 

  31. Hsu Y-S, Chien R-N, Yeh C-T, et al. Long-term outcome after spontaneous HBeAg seroconversion in patients with chronic hepatitis B. Hepatology. 2002;35(6):1522–7.

    Article  PubMed  Google Scholar 

  32. Fattovich G, Giustina G, Realdi G, et al. Long-term outcome of hepatitis B e antigen-positive patients with compensated cirrhosis treated with interferon alfa. Hepatology. 1997;26:1338–42.

    Article  PubMed  CAS  Google Scholar 

  33. Chen Y-C, Chu C-M, Liaw Y-F. Age specific prognosis following spontaneous hepatitis B e antigen seroconversion in chronic hepatitis B. Hepatology. 2010;51(2):435–44.

    PubMed  Google Scholar 

  34. Yuen M-F, Wong D, Sablon E, et al. HBsAg seroclearance in chronic hepatitis B in the Chinese: virological, histological, and clinical aspects. Hepatology. 2004;39(6):1694–701.

    Article  PubMed  Google Scholar 

  35. Sung JJY, Tsoi KKF, Wong VWS, et al. Meta-analysis: treatment of hepatitis B infection reduces risk of hepatocellular carcinoma. Aliment Pharmacol Ther. 2008;28:1067–77.

    Article  PubMed  CAS  Google Scholar 

  36. Liaw Y-F, Sung JJY, Chow WC, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med. 2004;351(15):1521–31.

    Article  PubMed  CAS  Google Scholar 

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Conflicts of interest: J. Urquhart—none; J.M. Schwartz—none.

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Correspondence to Jennifer Urquhart.

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Urquhart, J., Schwartz, J.M. Hepatocellular Carcinoma Surveillance in a Western Population with Hepatitis B. Curr Hepatitis Rep 10, 147–152 (2011). https://doi.org/10.1007/s11901-011-0098-y

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