title: Prospective study of screening for hepatocellular carcinoma in Caucasian patients with cirrhosis.
abstract: Screening is widely used to detect early hepatocellular carcinoma in Asian patients with cirrhosis. Its effectiveness in Caucasian patients has been suggested, but remains to be proven. Therefore we prospectively studied 118 French patients (68 males, 50 females, age 55 +/- 12) with Child-Pugh A or B cirrhosis (alcoholic in 82) and without detectable hepatocellular carcinoma. The screening program consisted of ultrasound examination of the liver and determination of blood alpha-fetoprotein and des-gamma-carboxyprothrombin levels every 6 months. The median follow up was 36 months (range 4-48). Only four patients were lost to follow up. Fourteen hepatocellular carcinomas were detected, in six cases by ultrasonography alone, in four by alpha-fetoprotein alone, in three by ultrasonography and alpha-fetoprotein and in one case by ultrasonography and des-gamma-carboxyprothrombin, but never by des-gamma-carboxyprothrombin alone. The tumor presented as a unique nodule in nine patients. The tumor was less than 3 cm in diameter without portal thrombosis or metastasis in three cases. Surgery was performed in only one case. In this study, the annual incidence of hepatocellular carcinoma was high (5.8%), but the screening methods used did not effectively identify potentially resectable tumors in Caucasian patients with cirrhosis.
authors.affiliation: Service d'Hépato-gastroentérologie, Hôpital Jean Verdier, Bondy, France.
authors.forename: D
authors.initials: D
authors.lastname: Pateron
authors.forename: N
authors.initials: N
authors.lastname: Ganne
authors.forename: J C
authors.initials: JC
authors.lastname: Trinchet
authors.forename: M H
authors.initials: MH
authors.lastname: Aurousseau
authors.forename: F
authors.initials: F
authors.lastname: Mal
authors.forename: C
authors.initials: C
authors.lastname: Meicler
authors.forename: E
authors.initials: E
authors.lastname: Coderc
authors.forename: P
authors.initials: P
authors.lastname: Reboullet
authors.forename: M
authors.initials: M
authors.lastname: Beaugrand
mesh_terms: D015415:Biomarkers; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000208:ethnology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000208:ethnology*; D008104:Liver Cirrhosis, Alcoholic / Q000208:ethnology*; D008113:Liver Neoplasms / Q000208:ethnology / Q000517:prevention & control*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors; D011516:Prothrombin / Q000031:analogs & derivatives / Q000032:analysis; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin