A 6-month versus a 12-month surveillance for hepatocellular carcinoma in 559 hemophiliacs infected with the hepatitis C virus

Abstract

Hepatocellular carcinoma (HCC) is an increasingly frequent cause of mortality in hemophiliacs with chronic viral hepatitis. Early diagnosis of the tumor at an initial stage is known to improve the outcome of HCC treatment. Because all HCC cases detected in a previous study based upon annual ultrasound (US) surveillance of hemophiliacs with elevated alanine aminotransferase levels were multinodular, this study was designed to evaluate if a more intense surveillance with US and alphafetoprotein (AFP) serum levels of all the patients infected with the hepatitis C virus (HCV) improved the identification of single nodule tumors. A multicenter cohort of 559 HCV-infected hemophiliacs was divided into 2 arms, one followed up at 6-month intervals and one at 12-month intervals depending on the choice and available facilities of each treatment center. During a 6-year surveillance period, HCC was diagnosed in 5 (2.4%) of 210 patients in the 6-month group and in 3 (0.9%) of 349 patients in the 12-month group. The overall incidence rate of HCC was 239 per 100 000 per year (397 per 100 000 per year in the 6-month group and 143 per 100 000 per year in the 12-month group; differences not statistically significant). By multivariate analysis, HCC risk was increased 12.9-fold with alcohol intake more than 80 g/d and 15.2-fold with AFP levels higher than 11 ng/mL. Liver-related death oc-

Management of hepatocellular carcinoma

“…148 Another study in HCV infected hemophiliacs without cirrhosis suggested that the likelihood of finding HCC at the single nodule stage (as opposed to multinodular HCC) was the same with 6 and 12 month surveillance intervals. 149 Thus, the surveillance interval remains controversial. Most experts use a 6-month interval, but there are no firm data to suggest that 6 months is better than 12 months.…”

Autoimmune Hepatitis, Cirrhosis, and Hepatocellular Carcinoma (HCC)

“…In contrast, the guidelines proposed by the American Association for study of Liver Diseases (AASLD) proposes that US be performed at 6-month intervals for all patients at risk of HCC regardless of the magnitude of risk but based on expected tumour doubling times. Although the retrospective study by Zhang et al used a surveillance interval of 6 months, [7] several other studies report that the likelihood of finding HCC at the single nodule stage is no different between 6-and 12-month surveillance intervals [12,13]. One nonrandomised prospective study in patients with hepatitis B has demonstrated that survival is greater when surveillance intervals are shortened to 6 months as opposed to 12 months [14].…”

The clinical management of hepatocellular carcinoma worldwide: A concise review and comparison of current guidelines from 2001 to 2017

“…A prospective cohort study found that patients with HBV had a better survival with a surveillance interval of 6 months than with 12 months (45). However, other studies have found no significant differences in survival or the rate of HCC detection with intervals of 6 and 12 months (46,47). Of the 18 guidelines that were reviewed here, 8 tended to recommend a surveillance interval of 6 months and 2 recommended an interval of 6 to 12 months.…”