Incidence of hepatocellular carcinoma in outpatients with cirrhosis in Brazil: A 10-year retrospective cohort study

Abstract

AIMTo determine the incidence of hepatocellular carcinoma (HCC) and the impact of HCC surveillance on early diagnosis and survival of cirrhotic outpatients.METHODSIn this retrospective cohort study, cirrhotic outpatients undergoing HCC surveillance between March 2005 and March 2014 were analyzed. Exclusion criteria were HIV coinfection; previous organ transplantation; diagnosis of HCC at first consultation; missing data in the medical chart; and less than 1 year of follow-up. Surveillance was carried out every six months using ultrasound and serum alpha-fetoprotein determination. Ten-year cumulative incidence and survival were estimated through Kaplan-Meier analysis.RESULTSFour hundred and fifty-three patients were enrolled, of which 57.6% were male. Mean age was 55 years. Hepatitis C virus and heavy use of alcohol were the main etiologic agents of cirrhosis. HCC was diagnosed in 75 patients (16.6%), with an estimated cumulative incidence of 2.6% in the 1st year, 15.4% in the 5th year, and 28.8% in the 10th year. Median survival was estimated at 17.6 mo in HCC patients compared to 234 mo in non-HCC patients (P < 0.001). Early-stage HCC was more often detected in patients who underwent surveillance every 6 mo or less (P = 0.05). However, survival was not different between patients with early stage vs non-early stage tumors [HR = 0.54 (0.15-1.89), P = 0.33].CONCLUSIONHCC is a frequent complication in patients with cirrhosis and adherence to surveillance programs favors early diagnosis.

Hepatitis B-related hepatocellular carcinoma: surveillance strategy directed by immune-epidemiology

“…The most relevant preventive measure is universal vaccination against HBV. In a Peruvian experience, HCC-related mortality decreased from 9.2 to 3.3/100,000 inhabitants after the institution of a vaccination program [41] . On the other hand, when chronic liver disease has been established, close attention must be paid to HCC surveillance.…”

“…On the other hand, when chronic liver disease has been established, close attention must be paid to HCC surveillance. Unfortunately, in different Latin American cohorts, only half of all HCC cases were diagnosed while patients were under surveillance programs [ 29 , 31 , 42 ] . Nevertheless, when individuals were under surveillance, HCC was diagnosed in earlier stages [ 29 , 42 , 43 ] , and survival rates were significantly higher [ 31 , 43 ] .…”

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“…52 Another cohort corroborated that individuals who attended ultrasound surveillance with a frequency of at least every 6 months had a higher probability of being diagnosed with early-stage tumors. 53 In terms of ultrasonography accuracy for HCC detection, a study performed in Argentina included 643 cirrhotic patients on liver transplantation waiting-list. In this study, the sensitivity was 33% and specificity was 99%.…”

Immune aspects of hepatocellular carcinoma: From immune markers for early detection to immunotherapy

“…Patients with cirrhosis presenting with liver nodules ≥1 cm on ultrasound should be referred for diagnostic evaluation of HCC with either a multiphasic computed tomography scan or magnetic resonance imaging[ 7 - 9 ]. Unfortunately, different studies demonstrate that only half of cases with HCC are diagnosed while patients are under surveillance, despite the association between diagnosis in a surveillance program and better prognosis[ 11 - 13 ]. HCC management depends on the stage of the disease.…”