Early detection of hepatocellular carcinoma increases the chance of treatment: Hong Kong experience

Abstract

The prognosis for patients with hepatocellular carcinoma (HCC) is poor because of the low chance of curative treatment. To increase the chance of intervention and to improve survival, early detection of subclinical HCC (SCHCC) by ␣-fetoprotein (AFP) and/or ultrasonography (USG) screening is implemented in many countries. Three hundred six Chinese patients with HCC diagnosed between January 1995 and December 1997 were recruited. They were categorized into two groups: 142 patients (group 1) had SCHCC diagnosed by screening (AFP and/or USG), and 164 patients (group 2) presented with symptomatic HCC. The tumor size was significantly smaller in group 1 compared with that of group 2 (3.5 cm vs. 8.1 cm; P F .0001). A significantly higher proportion of patients had bilobar involvement, multifocal HCC, diffuse-type HCC, portal vein infiltration, and distant metastasis in group 2 when compared with group 1. Operability and feasibility of treatment by transcatheter intra-arterial chemoembolization (TACE) in group 1 patients (26.8% and 45.1%, respectively) were significantly better than in group 2 patients (7.9% and 32.3%, P F .0001 and P ‫؍‬ .03, respectively). The cumulative survival rate was significantly higher in group 1 than in group 2 (P F .0001). For those who had surgical resection and those who had TACE, group 1 patients had a higher cumulative survival rate compared with that of group 2 patients (P ‫؍‬ .04 and P ‫؍‬ .0003, respectively). Screening for HCC by AFP and/or USG can identify tumors at an early stage, resulting in a higher chance of receiving treatment. Whether it can improve survival requires a further prospective, randomized study. (HEPATOLOGY 2000; 31:330-335.) Hepatocellular carcinoma (HCC) is one of the major health problems throughout the world. The annual incidence is estimated as 530,000 cases globally. 1 A recent study shows that the incidence of HCC is rising in the United States over the past 2 decades, with age-specific incidence shifting toward younger persons. 2 The problem is even more overwhelming in regions where the incidence of chronic viral hepatitis B and/or C is of high prevalence. The prognosis for patients with HCC is still dismal. At present, surgical resection and liver transplantation are the only forms of curative treatment available. However, the chance of curative treatment is often limited by several features of the HCC. HCCs are usually large in size before they give rise to symptoms. Bilobar or multifocal tumors are common. The incidence of associated cirrhosis is also high, being over 80% in most series. [3][4][5] The efficacy for other modalities of treatment, e.g., transcatheter intra-arterial chemoembolization (TACE), also depends on the above factors. 6 To increase the chance of intervention and, more importantly, to improve survival, early detection of subclinical HCC (SCHCC) by ␣-fetoprotein (AFP) and/or ultrasonography (USG) screening is implemented in many countries. Though studies of Asian populations show encouraging results, 7-9 these are not substantiated in...

Effect of surveillance for hepatocellular carcinoma on tumor staging and treatment decisions in Egyptian patients

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Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: A study of 1,401 patients across 3 decades

“…These results are consistent with several previous studies exploring evolutionary temporal trends in HCC. The role of HCC surveillance in chronic liver disease has become well established over the years, with benefits reported in several studies 42, 43, 44. Similarly, a significant improvement in diagnostic modalities, such as dynamic computerized tomography, contrast‐enhanced magnetic resonance imaging, and ultrasound, has also played an important role in detecting HCC earlier 35.…”

Ultrasound surveillance for early detection of hepatocellular carcinoma among patients with chronic hepatitis C

“…Surveillance for HCC is now a part of standard clinical practice for patients with chronic viral hepatitis [8]. Considering recent advances in HCC treatments, surveillance is required to detect HCC while tumors are small enough for the indication of curative treatments such as surgical resection and radiofrequency ablation [9][10][11][12][13].…”