Natural history of hepatocellular carcinoma

Colombo, Massimo

doi:10.1102/1470-7330.2005.0014

Cited by 25 publications

(22 citation statements)

References 29 publications

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“…Since the hepatocarcinogenetic process may evolve for years in a stepwise fashion from premalignant to overt HCC [9], detection of early, better treatable tumors is made possible by surveillance of patients at-risk. The two most common tests used for screening are ultrasonography (US) of the liver and serum a-FP level either individually or in combination.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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Purpose Egyptian hepatocellular carcinoma (HCC) patients present at advanced stages. We aimed to study the influence of surveillance versus non-surveillance on HCC staging and the potential therapeutic options. Methods A retrospective study to evaluate the effect of surveillance on early detection of HCC among cirrhotic patients from 2003 to 2008. Patients examined every 6 months using ultrasound and a-fetoprotein (a-FP) (group A) and those diagnosed with those that present for the first time symptomatically or incidentally (group B). Groups were compared for a-FP level, tumour characteristics, severity of liver disease; tumour staging was evaluated by Okuda, CLIP and BCLC staging systems, in addition to the potential therapeutic options. Results Group A comprised 122 HCC cases and group B 473. Surveillance improved HCC detection: at the stage of single nodule in 62.3% in group A versus 52.2% in group B, (P = 0.046) and reduced the percentage of HCC with portal vein thrombosis in 16.4 versus 33.8%, (P = 0.000) and the percentage of a-FP [400 ng/ml in 19.5 versus 32.6%, (P = 0.006) in groups A and B, respectively. Surveillance doubled the detection of HCC at early stage of BCLC (25.4 vs. 11.9% P = 0.000) and doubled the patients' chance for loco-regional ablation (12.3 vs. 5.9%, P = 0.015) and liver transplantation (10.7 vs. 3.2%, P = 0.001) in groups A and B, respectively. Conclusion HCC surveillance increases early detection of HCC and doubled the chances for curative options. Implementation of both HCC surveillance and cadaveric liver transplantation programs should be recommended in Egypt.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2010

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“…1 The most common causes of chronic liver disease-underlying HCC are hepatitis B or C infection and alcohol abuse. Cholestatic, autoimmune, and inherited metabolic disorders are other potential but much more uncommon causes.…”

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confidence: 99%

Obesity and diabetes as a risk factor for hepatocellular carcinoma

et al. 2004

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Ten percent of patients who undergo resection for hepatocellular carcinoma (HCC) associated with chronic liver disease have no detectable cause for this underlying liver disease. Recent studies have shown that patients with cryptogenic chronic liver disease frequently have risk factors for nonalcoholic fatty liver disease (NAFLD). This study examines the incidence of risk factors for NAFLD in patients with chronic liver disease who underwent resection for HCC. Among 210 patients with chronic liver disease who underwent resection for HCC, 18 (8.6%) had no identifiable cause for the underlying liver disease. These patients were assessed for obesity, diabetes mellitus, and histological features of the tumor and the adjacent liver parenchyma. Comparisons were made with matched patients with alcohol-and chronic-viral-hepatitis-related HCC. The prevalence of obesity (50% vs. 17% vs. 14%), diabetes (56% vs. 17% vs. 11%), aspartate aminotransferase / alanine aminotransferase ratio < 1 (50% vs. 19% vs. 17%), and steatosis > 20% (61% vs. 17% vs. 19%) was significantly higher in patients with cryptogenic liver disease than in patients with alcohol abuse and chronic viral hepatitis (P < 0.0001 for each). Well-differentiated tumors were significantly more common in patients with cryptogenic liver disease (89% vs. 64% in patients with alcohol-related HCC vs. 55% in patients with chronic viral hepatitis-related HCC, P < 0.0001). In conclusion, the hypothesis that obesity and diabetes mellitus may be important risk factors for cryptogenic chronic liver disease in patients with HCC is supported by the analysis of surgically treated patients. Whether HCC is primarily related to obesity and diabetes mellitus or secondarily to a NAFLD-like parenchymal lesions remains to be clarified. (Liver Transpl 2004;10: S69 -S73.)

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“…Patients with advanced cirrhosis and HCC have a poor prognosis, and in one series of 62 untreated patients, the median survival was 0.7 months with no patients surviving >3 months [7]. Transplantation is the best option for this group, but the limited donor pool has forced the organ allocation system to adopt parameters that are aimed at allocating organs to those with HCC whose survival will be as good as those who receive transplantation without any cancer [13].…”

Section: Discussionmentioning

confidence: 98%

“…In the United States, after skin cancer, its incidence is increasing more rapidly than any other tumor type [11]. HCC is an endstage manifestation of chronic liver injury and is almost always seen in the setting of advanced cirrhosis [7]. In the United States, alcoholic cirrhosis remains the most common cause of HCC [18].…”

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confidence: 99%