Outcome of 67 Patients With Hepatocellular Cancer Detected During Screening of 1125 Patients With Chronic Hepatitis

Izzo, Francesco; Cremona, Francesco; Ruffolo, F.; Palaia, Raffaéle; Parisi, Valerio; Curley, Steven A.

doi:10.1097/00000658-199804000-00011

Cited by 67 publications

(43 citation statements)

References 18 publications

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“…Screening with alpha fetoprotein levels has been shown to range from insensitive (< 20%) to moderately sensitive (> 80%) as the cut-off point decreases from 400 µg/L to 10 µg/L, at the cost of dramatically decreasing specificity. [143][144][145][146][147][148][149][150] Screening with ultrasound has varying sensitivities but generally high specificity (> 90%). 146,147,151,152 Combining ultrasound with tests for alpha fetoprotein levels may have better sensitivity than either modality alone.…”

Section: Other Management Issuesmentioning

confidence: 99%

Hepatitis C: a review for primary care physicians

Wong

Lee²

2006

Canadian Medical Association Journal

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Primary care physicians see many of the estimated 250 000 Canadians chronically infected with the hepatitis C virus (HCV). Of this number, about one-third are unaware they are infected, which constitutes a large hidden epidemic. They continue to spread HCV unknowingly and cannot benefit from advances in antiviral therapy that may clear them of the virus. Many HCV-infected people remain asymptomatic, which means it is important to assess for risk factors and test patients accordingly. The third-generation enzyme immunoassay for HCV antibodies is a sensitive and specific test, although the presence of the virus can be confirmed by polymerase chain reaction testing for HCV RNA in some circumstances. Pegylated interferon-α and ribavirin combination therapy clears the virus in about 45%-80% of patients, depending on viral genotype. Preventive strategies and counselling recommendations are also reviewed. CMAJ 2006;174(5):649-59 Abstract

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Section: Other Management Issuesmentioning

confidence: 99%

Hepatitis C: a review for primary care physicians

Wong

Lee²

2006

Canadian Medical Association Journal

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“…After reviewing titles and abstracts, 54 articles were retrieved for full-text evaluation. Thirty-seven of them were excluded: 32 did not provide sensitivity for tumors less than 5 cm in diameter [15,19,21,22,, 3 recruited patients without chronic hepatitis [46,52,63], and 5 articles did not provide specificity [56,[64][65][66][67]. Finally, 17 articles were included in our study (Fig.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

et al. 2007

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Background and aims The role of alphafetoprotein (AFP) in the diagnosis and surveillance of hepatocellular carcinoma (HCC) is getting smaller owing to the advances in imaging modalities. The aims of this study were to assess the diagnostic accuracy of tumor markers in small HCC and to find the optimal cutoff value of each tumor marker for efficient surveillance. Methods Studies in all languages were identified by searching MEDLINE from 1982 to 2002. Studies were included when they showed sensitivity and specificity for HCCs 5 cm or smaller and recruited only patients with chronic hepatitis or liver cirrhosis as control. We assessed diagnostic odds ratios (DORs) for the evaluation of diagnostic accuracy of tumor markers and positive likelihood ratios (LRs+) to find the optimal cutoff value. DORs and LRs+ were combined according to the random effect model. The summary receiver operating characteristics (ROC) curve was also assessed. Results Seventeen articles on three tumor markers-AFP, des-gamma-carboxyprothrombin (DCP), and Lens culinaris agglutinin-reactive fraction of AFP (AFP-L3)-were enrolled after full-text evaluation. AFP was inferior to DCP and AFP-L3 in both DOR (4.50 vs. 8.16 and 10.50) and area under the ROC curve (0.647 vs. 0.688 and 0.695). Optimal cutoff values that provide the best LR+ were 200 ng/ml for AFP, 40 mAU/ml for DCP, and 15% for AFP-L3. Conclusions Diagnostic accuracy of AFP in small HCC was substantially limited. Surveillance including other tumor markers with optimal cutoff value should be conducted to confirm the efficacy of the policy.

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“…It has been suggested that screening programs may be more beneficial to patients with cirrhosis. 17 According to Izzo et al, 18 98.5% of patients with HCC had either cirrhosis or chronic active hepatitis. Group 1 patients had a significantly smaller tumor size compared with group 2 patients (3.5 cm vs. 8.1 cm; P Ͻ .0001).…”

Section: Discussionmentioning

confidence: 99%

“…Taking the 95% CI for the true value as (proportion of cases ϩ 2 ϫ SE), the number of patients needed to be screened to detect one HCC was 14 (95% CI: 12-17). The corresponding number of patients needed to be screened for detecting one HCC that was treatable was 20 (95% CI: [16][17][18][19][20][21][22][23][24]. The cost for performing one AFP testing is estimated (in U.S. dollars) to be around $25, and one USG is approximately $100.…”

Section: Demographic Data and Liver Functionmentioning

confidence: 99%

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

et al. 2000

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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...

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Outcome of 67 Patients With Hepatocellular Cancer Detected During Screening of 1125 Patients With Chronic Hepatitis

Abstract: ObjectiveWe performed this prospective screening trial in chronic hepatitis virus-infected patients to determine the incidence of hepatocellular cancer (HCC) and the resectability and longterm survival rates of these HCC patients. Summary Background Data

Cited by 67 publications

References 18 publications

Hepatitis C: a review for primary care physicians

Hepatitis C: a review for primary care physicians

Diagnostic accuracy of tumor markers for hepatocellular carcinoma: a systematic review

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

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