Journal of Gastroenterology

, Volume 45, Issue 1, pp 105–112 | Cite as

Regular surveillance by imaging for early detection and better prognosis of hepatocellular carcinoma in patients infected with hepatitis C virus

  • Ikue Noda
  • Mikiya Kitamoto
  • Hideki Nakahara
  • Ryohei Hayashi
  • Tomoaki Okimoto
  • Yoshio Monzen
  • Hiroyasu Yamada
  • Masaru Imagawa
  • Nobuhiko Hiraga
  • Junko Tanaka
  • Kazuaki Chayama
Original Article—Liver, Pancreas, and Biliary Tract

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.

Keywords

Hepatocellular carcinoma Early detection Curative procedures Survival rates Surveillance 

References

  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.CrossRefPubMedGoogle Scholar
  2. 2.
    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.CrossRefPubMedGoogle Scholar
  3. 3.
    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.PubMedCrossRefGoogle Scholar
  4. 4.
    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.CrossRefPubMedGoogle Scholar
  5. 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.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol. 2004;130:417–22.PubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    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.CrossRefPubMedGoogle Scholar
  11. 11.
    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.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    Llovet JM, Beaugrand M. Hepatocellular carcinoma: present status and future prospects. J Hepatol. 2003;38:S136–49.CrossRefPubMedGoogle Scholar
  14. 14.
    Bruix J, Sherman M, Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–36.CrossRefPubMedGoogle Scholar
  15. 15.
    El-Serag HB, Rudolph KL. Hepatocellular carcinoma: epidemiology and molecular carcinogenesis. Gastroenterology. 2007;132:2557–76.CrossRefPubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    Liver Cancer Study Group of Japan. General rules for the clinical and pathological study of primary liver cancer. 2nd English ed. Tokyo: Kanehara; 2003.Google Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Schwartz M, Roayaie S, Konstadoulakis M. Strategies for the management of hepatocellular carcinoma. Nat Clin Pract Oncol. 2007;4:424–32. Review.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    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.PubMedGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar
  25. 25.
    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.CrossRefPubMedGoogle Scholar
  26. 26.
    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.Google Scholar
  27. 27.
    Takayasu K. Hepatic angiography. In: Okuda K, Tabor E, editors. Liver cancer. New York: Churchill Livingstone; 1997. p. 347–59.Google Scholar
  28. 28.
    Nakashima Y, Nakashima O, Hsia CC, Kojiro M, Tabor E. Vascularization of small hepatocellular carcinomas: correlation with differentiation. Liver. 1999;19:12–8.CrossRefPubMedGoogle Scholar
  29. 29.
    Kojiro M, Nakashima O. Histopathologic evaluation of hepatocellular carcinoma with special reference to small early stage tumors. Semin Liver Dis. 1999;19:287–96.CrossRefPubMedGoogle Scholar
  30. 30.
    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.CrossRefPubMedGoogle Scholar
  31. 31.
    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.CrossRefPubMedGoogle Scholar
  32. 32.
    El-Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology. 2004;126:460–8.CrossRefPubMedGoogle Scholar
  33. 33.
    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.CrossRefPubMedGoogle Scholar
  34. 34.
    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.CrossRefPubMedGoogle Scholar
  35. 35.
    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.CrossRefPubMedGoogle Scholar
  36. 36.
    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.CrossRefPubMedGoogle Scholar
  37. 37.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2009

Authors and Affiliations

  • Ikue Noda
    • 1
    • 4
  • Mikiya Kitamoto
    • 1
  • Hideki Nakahara
    • 2
  • Ryohei Hayashi
    • 1
  • Tomoaki Okimoto
    • 3
  • Yoshio Monzen
    • 3
  • Hiroyasu Yamada
    • 1
  • Masaru Imagawa
    • 1
  • Nobuhiko Hiraga
    • 4
  • Junko Tanaka
    • 5
  • Kazuaki Chayama
    • 4
  1. 1.Department of GastroenterologyHiroshima Prefectural HospitalHiroshimaJapan
  2. 2.Department of SurgeryHiroshima Prefectural HospitalHiroshimaJapan
  3. 3.Department of RadiologyHiroshima Prefectural HospitalHiroshimaJapan
  4. 4.Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical ResearchHiroshima UniversityHiroshimaJapan
  5. 5.Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical SciencesHiroshima UniversityHiroshimaJapan

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