Journal of Gastrointestinal Cancer

, Volume 50, Issue 1, pp 48–53 | Cite as

Hepatocellular Carcinoma Surveillance—Experience from Croatian Referral Centre for Chronic Liver Diseases

  • Matea Majerović
  • Mislav JelakovićEmail author
  • Marina Premužić
  • Ivana Knežević Štromar
  • Davor Radić
  • Marko Mance
  • Stjepko Pleština
  • Rajko Ostojić
  • Nadan Rustemović
  • Zeljko Krznarić
Original Research



For patients at high-risk of developing hepatocellular carcinoma (HCC), biannual ultrasound surveillance has long been recommended, in order to detect the tumor in the early, potentially curative stages. However, globally reported HCC surveillance rates vary greatly, ranging from as low as 1.7 to as high as 80%. Our aim was to assess the utilization of surveillance with biannual ultrasound in high-risk Croatian patients and to identify the factors that impact the implementation of the recommended protocol.


This retrospective study included 145 newly diagnosed HCC patients in the period from January 2010 to September 2015. We identified low-risk and high-risk patients. The latter were further subdivided into the regular biannual ultrasound surveillance group and the non-surveillance group. The groups were compared according to demographic characteristics and BCLC stage at the time of HCC diagnosis.


Among 145 patients, 80 patients were classified as high-risk according to EASL criteria. During the relevant period, 28.7% underwent regular surveillance, while 71.25% did not. Younger patients were more likely to undergo surveillance (OR 0.935 CI 0.874–0.999; p = 0.05). The patients who underwent regular surveillance had a higher chance of being diagnosed at a curative stage (BCLC 0 or A) (OR 3.701 CI 1.279–10.710; p < 0.05).Gender was not a predictor of participation in the regular surveillance protocol. Among the high-risk patients who did not undergo regular surveillance, 56.1% were not aware of the chronic liver disease prior to the HCC diagnosis.


HCC surveillance is still underutilized in high-risk Croatian patients despite its obvious benefits possibly due to the untimely diagnosis of the chronic liver disease.


Hepatocellular carcinoma Surveillance Ultrasonography 



This study was conducted as an original study at the Department of Gastroenterology, University Hospital Centre Zagreb, which is a referral center for treatment of chronic liver diseases.

Compliance with Ethical Standards

This study was approved by the ethics committee of the University Hospital Centre Zagreb (approval number—02/21 AG) and was conducted in compliance with the Helsinki Declaration.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Matea Majerović
    • 1
  • Mislav Jelaković
    • 1
    Email author
  • Marina Premužić
    • 1
  • Ivana Knežević Štromar
    • 1
  • Davor Radić
    • 1
  • Marko Mance
    • 2
  • Stjepko Pleština
    • 3
  • Rajko Ostojić
    • 1
  • Nadan Rustemović
    • 1
  • Zeljko Krznarić
    • 1
  1. 1.Department of Gastroenterology and HepatologyUniversity Hospital Centre ZagrebZagrebCroatia
  2. 2.Department of SurgeryUniversity Hospital Centre ZagrebZagrebCroatia
  3. 3.Department of OncologyUniversity Hospital Centre ZagrebZagrebCroatia

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