Are hepatocellular carcinoma surveillance programs effective at improving the therapeutic options?: ¿mejoran las opciones terapéuticas de estos pacientes?

Abstract

Aim: to evaluate whether the current surveillance programs (ultrasonography and alpha-fetoprotein testing every six months) are successful in detecting patients in the early stages. Material and methods: the health records of all patients diagnosed with hepatocellular carcinoma in Donostia Hospital between 2003 and 2005 were reviewed retrospectively. Eightyfive patients (11 women and 74 men) were included in the study and demographic data, risk factors and clinical data were obtained. Patients were split into two groups according to whether or not they had been included in a surveillance program. Results: seventy per cent of patients of the surveillance group is diagnosed in early stage opposite to 26.7% of patients in no surveillance group (p < 0.05). Thirteen patients cannot receive curative treatment in spite of the diagnosis in early stage (9 in the surveillance group and 4 in the no surveillance group. The global sensibility of the surveillance program in our series is 95%. Conclusions: current hepatocellular carcinoma surveillance programs, which comprise six-monthly ultrasonography and alpha-fetoprotein tests, are highly sensitive and effective. These programs result in the detection of hepatocellular carcinoma in its early-stages, when potentially curative treatment may be offered.

Early Detection, Curative Treatment, and Survival Rates for Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis: A Meta-analysis

“…We identified 47 studies, with a total of 15,158 patients, assessing the impact of HCC surveillance on at least one outcome of interest [17]–[63]. Of these patients, 6,284 (41.4%) HCC were detected by surveillance and 8,874 (58.6%) presented symptomatically or were found incidentally outside of a surveillance protocol.…”

“…Thirty-eight studies, with a total of 10,904 patients, included data on tumor stage stratified by receipt of HCC surveillance [17],[18],[20],[21],[23]–[26],[28],[29],[31]–[50],[52]–[55],[57],[59],[61],[63]. Twenty-four studies defined early stage using BCLC or Milan criteria [17],[18],[24],[29],[32]–[35],[37],[38],[41]–[45],[47]–[49],[52],[53],[55],[57],[61],[63], whereas six studies used other staging systems (e.g., tumor node metastases [TNM]) [23],[31],[39],[46],[54],[59], and eight used operational definitions (e.g., unifocal lesion less than 3 cm) [20],[21],[25],[26],[28],[36],[40],[50] (Table 1).…”

Ultrasound Imaging of Liver Tumors – Current Clinical Applications

“…The efficiency of such a program is linked to the functional liver parenchyma of the cirrhotic patient. Therefore, some authors argue that screening should be excluded in patients with etiologies that prevent curative treatment or in patients with advanced liver disease (Child-Pugh class C) (Zapata et al, 2010).…”

Factors related to survival in hepatocellular carcinoma in the geographic area of Sabadell (Catalonia, Spain)

“…It has been questioned whether screening can improve survival. However, such programs have been shown to be able to detect smaller lesions, and this in turn allows the provision of treatment with curative intent (7,10,29). Consequently, screening indirectly contributes to lessen patient mortality.…”

“…However, its epidemiological characteristics, incidence and risk factors vary among different geographical settings (2)(3)(4). Chronic hepatitis B virus (HBV) infection is the main risk factor in Asia and Africa, while in Western countries (including Spain) and in Japan, chronic hepatitis C virus (HCV) infection is the main risk factor for HCC (5)(6)(7)(8)(9)(10).…”