Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance☆

Sangiovanni, A.; Ninno, E. Del; Fasani, P.; Fazio, Caterina; Ronchi, G.; Roméo, R.; Morabito, Alberto; Franchis, Roberto de; Colombo, Massimo

doi:10.1053/j.gastro.2003.12.049

Cited by 554 publications

(396 citation statements)

References 28 publications

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“…Only two of them (Benvegnu`et al, 1994;Chiaramonte et al, 1998) showed an additive synergism between the two infections, while the others (Zoli et al, 1996;Del Olmo et al, 1998;Benvegnu`et al, 2004;Sangiovanni et al, 2004) showed independence between the two infections in causing HCC.…”

Section: Overt Hepatitis B Virus Infectionmentioning

confidence: 95%

“…A case-control study in Taiwan showed a dose-response relation between hepatic levels of 4-aminobiphenyl DNA-adducts and the OR for HCC in HBsAg-negative subjects (Wang et al, 1998). A cohort study performed in Italy among cirrhotics of various aetiology (Sangiovanni et al, 2004) found a hazard ratio of 1.7 for HCC development among smokers compared to non-smokers when controlling for aetiology of cirrhosis, the risk for smokers of >20 being higher than that for smokers of 1-20 cigarettes/day (Sangiovanni A, personal communication).…”

Section: Tobacco Smokingmentioning

confidence: 99%

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Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

et al. 2006

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Hepatitis B virus (HBV), hepatitis C virus (HCV) and alcohol consumption are major causes of hepatocellular carcinoma (HCC) worldwide. We performed a systematic review of epidemiologic studies carried out on HCC aetiology in Southern Europe, an area with an intermediatehigh prevalence of these agents as well as of putative risk factors such as tobacco smoking, diabetes and obesity. To retrieve the articles, we performed a Medline search for titles and abstracts of articles. After the Medline search, we reviewed the papers and reference lists to identify additional articles. A synergism between HCV infection and HBV infection, overt (hepatitis B virus antigen (HbsAg) positivity) or occult (HBsAg negativity with presence of HBV DNA in liver or serum), is suggested by the results of some studies. The pattern of the risk for HCC due to alcohol intake shows a continuous dose-effect curve without a definite threshold, although most studies found that HCC risk increased only for alcohol consumption above 40-60 g of ethanol per day. Some evidence supports a positive interaction of alcohol intake probably with HCV infection and possibly with HBV infection. A few studies found that coffee has a protective effect on HCC risk due to various risk factors. Some data also support a role of tobacco smoking, diabetes and obesity as single agents or preferably cofactors in causing HCC. In countries with a relatively high alcohol consumption and intermediate levels of HCV and HBV infections (1-3% of population infected by each virus), such as Mediterranean countries, the three main risk factors together account for about 85% of the total HCC cases, leaving little space to other known risk factors, such as haemochromatosis, and to new, still unrecognised, factors as independent causes of HCC.

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Section: Overt Hepatitis B Virus Infectionmentioning

confidence: 95%

Section: Tobacco Smokingmentioning

confidence: 99%

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

et al. 2006

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“…32 In clinic-based surveillance studies in Italy and Taiwan, liver-specific mortality rates were reduced in cirrhotic patients with HCC detected during surveillance. 33,34 Retrospective studies from Taiwan, Hong Kong and Italy also reported small and potentially curable HCC being detected in the surveillance groups and leading to improved patient survival. 35 …”

Section: Role Of Dedicated Hepatocellular Carcinoma Surveillance Progmentioning

confidence: 99%

Role of Surveillance in Prevention of Hepatocellular Carcinoma

Panda

2014

Journal of Clinical and Experimental Hepatology

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Hepatocellular carcinoma is a common malignancy and one of the important public health problems in India. The surveillance of hepatocellular carcinoma (HCC) is an established approach to detect early cancers in patients with defined risks. However, there are still controversies and issues to be addressed regarding the optimal surveillance methods and interval. The current level of awareness among physicians in India about surveillance is low and the need and most cost effective surveillance strategy in developing country like ours is unclear. This article has tried to discuss these issues in their appropriate perspective. To address this complicated issue, a multicenter randomized prospective study however may be required. ( J CLIN EXP HEPATOL 2014;4:S43-S49) H epatocellular carcinoma (HCC) is the fifth commonest cancer worldwide and third commonest cause of cancer related mortality. 1 In India, the mean incidence of HCC as per four population-based registries was 2.77% for males and 1.38% for females. The prevalence of HCC in India varies from 0.2% to 1.6%. 2,3 It is interesting to note that the consolidated data from cancer registries of India do not reflect HCC as an important malignancy. 4 Risk of HCC development is high in patients with liver cirrhosis of any etiology, particularly with chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. 5 Since India has a high prevalence of HBV infection (4% of population, i.e about 40 million Indians) 6 as well as HCV infection (0.3-1.5%) it could contribute to the high incidence of HCC. 7 Other risk factors for HCC like high prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) obesity, diabetes, alcohol consumption among males are also present in India.Nonalcoholic Fatty Liver Disease (NAFLD) particularly its more aggressive form, nonalcoholic steatohepatitis (NASH) is an important factor which can lead to cirrhosis and HCC. It is estimated that nearly two-thirds of obese people have some form of fatty liver, ranging from steatosis to NASH. NASH can progress to liver cirrhosis in 3%-15% and subsequently to liver cancer. 8 A study by Prasad et al showed that age-standardized prevalence rates of metabolic syndrome were 33.5% overall, 24.9% in males and 42.3% in females in India. Authors concluded that metabolic syndrome is a significant public health problem even in one of the poorest states of India. 9 Hence NASH is particularly important in countries like India where metabolic syndrome is on the rise.It is important to note that in the absence of an effective screening program and only 7% of population being covered by cancer registries, under reporting cannot be ruled out. 10 A recent study in which 130 trained physicians independently assigned causes to 122429 deaths, which occurred in 1$1 million homes in 6671 small areas that were randomly selected to be representative of all of India, based on a structured nonmedical surveyor's field report has put the liver cancer as the 4th commonest cause of death in male and 8th commonest cause of death i...

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“…7,8,[11][12][13][14] These studies are not free from lead time bias (better survival due to anticipated diagnosis of HCC) and length bias (surveillance picking up slow growing tumors) since they are uncontrolled. But when corrected for lead time bias, there was still significant improvement in survival.…”

Section: Efficacy Of Surveillancementioning

confidence: 99%

“…16 Moreover, many studies also showed a favorable tumor stage detected on surveillance. 7,8,12 In fact, the risk of finding an advanced HCC is reduced by 70% in patients who are on surveillance. 14 Since surveillance increases the applicability of curative options with almost 50% 5-year survival rates, it actually decreases disease related mortality.…”

Section: Efficacy Of Surveillancementioning

confidence: 99%

Surveillance for Hepatocellular Carcinoma

Ramachandran

2014

Journal of Clinical and Experimental Hepatology

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Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance☆

Cited by 554 publications

References 28 publications

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

Southern Europe as an example of interaction between various environmental factors: a systematic review of the epidemiologic evidence

Role of Surveillance in Prevention of Hepatocellular Carcinoma

Surveillance for Hepatocellular Carcinoma

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