Screening for hepatocellular carcinoma

Sherman, Morris

doi:10.1016/j.bpg.2004.11.006

Cited by 32 publications

(12 citation statements)

References 106 publications

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“…In contrast, studies in different populations showed that association between A1ATD phenotypes and HCC is either non-existent or very weak (41-45). In a review article, Sherman (46) was concluded that there was insufficient data to determine whether screening for HCC might be beneficial for patients with cirrhosis caused by A1ATD. Several case-report studies have reported associations between A1ATD and HCC: a 16-year-old PiMZ boy with hepatocellular carcinoma (47); a PiMZ patient with hepatocellular carcinoma in a non-cirrhotic liver (48); and a primary liver cell carcinoma as a complication in a 67-year-old PiZZ patient (49).…”

Section: Resultsmentioning

confidence: 99%

Alpha 1 Antitrypsin in Pathogenesis of Hepatocellular Carcinoma

2012

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ContextAlpha-1-antitrypsin (A1AT) is the most abundant liver-derived, highly polymorphic, glycoprotein in plasma. Hereditary deficiency of alpha-1-antitrypsin in plasma (A1ATD) is a consequence of accumulation of polymers of A1AT mutants in endoplasmic reticulum of hepatocytes and other A1AT-producing cells. One of the clinical manifestations of A1ATD is liver disease in childhood and cirrhosis and/or hepatocellular carcinoma (HCC) in adulthood. Epidemiology and pathophysiology of liver failure in early childhood caused by A1ATD are well known, but the association with hepatocellular carcinoma is not clarified. The aim of this article is to review different aspects of association between A1AT variants and hepatocellular carcinoma, with emphasis on the epidemiology and molecular pathogenesis. The significance of A1AT as a biomarker in the diagnosis of HCC is also discussed.Evidence AcquisitionsSearch for relevant articles were performed through Pub Med, HighWire, and Science Direct using the keywords “alpha-1-antitrypsin”, “liver diseases”, “hepatocellular carcinoma”, “SERPINA1”. Articles published until 2011 were reviewed.ResultsEpidemiology studies revealed that severe A1ATD is a significant risk factor for cirrhosis and HCC unrelated to the presence of HBV or HCV infections. However, predisposition to HCC in moderate A1ATD is rare, and probably happens in combination with HBV and/or HCV infections or other unknown risk factors. It is assumed that accumulation of polymers of A1ATD variants in endoplasmic reticulum of hepatocytes leads to damage of hepatocytes by gain-of-function mechanism. Also, increased level of A1AT was recognized as diagnostic and prognostic marker of HCC.ConclusionsClarification of a carcinogenic role for A1ATD and identification of proinflammatory or some still unknown factors that lead to increased susceptibility to HCC associated with A1ATD may contribute to a better understanding of hepatic carcinogenesis and to the development of new drugs.

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Section: Resultsmentioning

confidence: 99%

Alpha 1 Antitrypsin in Pathogenesis of Hepatocellular Carcinoma

2012

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“…Over the study period, there was a progressive increase in detection of HCC at early stages when it is potentially curable. These improvements may also be influenced by robust screening and clinical surveillance of individuals with known risk factors for HCC . Despite the encouraging findings, a majority of eligible cases received neither surgical nor local tumor destruction therapy.…”

Section: Discussionmentioning

confidence: 99%

“…These improvements may also be influenced by robust screening and clinical surveillance of individuals with known risk factors for HCC. [16][17][18][19] Despite the encouraging findings, a majority of eligible cases received neither surgical nor local tumor destruction therapy. The low rate of intervention observed may reflect advanced disease not amenable for ablation, resection, or transplant.…”

Section: Discussionmentioning

confidence: 99%

Emerging trends in hepatocellular carcinoma incidence and mortality

et al. 2014

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The rise in incidence of hepatocellular carcinoma (HCC) in the United States has been well documented. The purpose of this analysis was to examine temporal trends in HCC incidence, mortality, and survival within the U.S. population. The Surveillance, Epidemiology, and End Results data were used to examine incidence and incidence-based (IB) mortality in HCC from 1973 to 2011. Secular trends in age-adjusted incidence and IB mortality by sex and cancer stage were characterized using the Joinpoint Regression program. In 1973, HCC incidence was 1.51 cases per 100,000, whereas in 2011, HCC incidence was 6.20 cases per 100,000. Although HCC incidence continues to increase, a slowing of the rate of increase occurs around 2006. In a sensitivity analysis, there was no significant increase in incidence and IB mortality from 2009 to 2011. There was a significant increase in overall median survival from the 1970s to 2000s (2 vs. 8 months; P < 0.001). On multivariable Cox's regression analysis, age, sex, race, tumor grade, stage at diagnosis, lymph/vascular invasion, number of primary tumors, tumor size, and liver transplant were independently associated with mortality. Conclusion Our results indicate a deceleration in the incidence of HCC around 2006. Since 2009 and for the first time in four decades, there is no increase in IB mortality and incidence rates for HCC in the U.S. population. The nonsignificant increase in incidence and IB mortality in recent years suggest that the peak of the HCC epidemic may be near. A significant survival improvement in HCC was also noted from 1973 to 2010, which seems to be driven by earlier detection of HCC at a curative stage and greater utilization of curative modalities (especially transplant).

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“…There have been many retrospective studies suggesting benefit, which have suffered from potential lead and length time biases. 21 To date, there has been only one randomized trial showing a benefit from screening, a study of hepatitis B patients in China which found a 37% reduction in mortality. 22 …”

Section: Discussionmentioning

confidence: 99%

Decreasing disparity in liver transplantation among white and Asian patients with hepatocellular carcinoma

Robbins

Daily

Aoki

et al. 2008

Cancer

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Background A preliminary study using national cancer surveillance data from 1998–2002 suggested there were significant differences between non-Hispanic whites (“whites”) and Asian/Pacific Islanders (APIs) in the use of liver transplantation as a treatment for hepatocellular carcinoma (HCC). Methods We conducted a study to examine whether differences in liver transplantation between white and API HCC patients were changing over time. Using a population-based statewide cancer registry, we obtained data on all HCC cases diagnosed in California between 1998 and 2005, but limited the study to white and API patients with non-metastatic HCC, sized ≤ 5.0 cm (n = 1728). Results During 1998–2003 (n = 1051), the odds of receiving a liver transplant were 2.56 times higher for white patients than for API patients (95% confidence interval [CI], 1.72 to 3.80 times higher), even after adjusting for age, sex, marital status, year of diagnosis, TNM stage, and tumor grade. In contrast, during 2004–2005 (n = 677), there were no significant differences in the odds of receiving a transplant. Between 2002 and 2004, changes in liver transplantation policy assigned priority points to HCC patients (initially to stage I and II, then to stage II only). After the policy changes, API HCC patients experienced a significant increase in stage II diagnoses, while white patients did not. Conclusions In California, there was a large and significant disparity in liver transplantation among white and API patients with HCC during 1998–2003, but not during 2004–2005. Changes in liver transplantation policy during 2002–2004 may have played a role in decreasing this difference.

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Screening for hepatocellular carcinoma

Cited by 32 publications

References 106 publications

Alpha 1 Antitrypsin in Pathogenesis of Hepatocellular Carcinoma

Alpha 1 Antitrypsin in Pathogenesis of Hepatocellular Carcinoma

Emerging trends in hepatocellular carcinoma incidence and mortality

Decreasing disparity in liver transplantation among white and Asian patients with hepatocellular carcinoma

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