title: Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance.
abstract: OBJECTIVE
  Significant improvements in management of hepatocellular carcinoma (HCC) have occurred in the last years, but their impact on surveillance outcome is unknown. To clarify this, we compared survival of HCC patients identified along 3 consecutive quinquennia of surveillance.
  
  
  METHODS
  A cohort of 417 HCC-free outpatients with compensated cirrhosis was prospectively followed for 148 months (range, 1-213 months) with periodic ultrasound examinations.
  
  
  RESULTS
  HCC developed in 112 patients, at a 3.4% rate per year, and was the prime cause of death (n = 54). Forty-six (41%) patients had a single tumor, with a mean size of 3.7 cm, 3.0 cm, and 2.2 cm in the 3 quinquennia (first vs. second: ns; first vs. third: P = 0.017; second vs. third: P = 0.02), and 38 (44%) underwent radical therapy. Mortality rates in HCC patients fell from 45% in the first quinquennium to 37% in the second and 10% in the third (first vs. second: ns; first vs. third: P = 0.0009; second vs. third: P = 0.018) in parallel with a reduction in yearly mortality of treated patients (34%, 28%, and 5%, respectively; first vs. second: ns; second vs. third: P = 0.036; first vs. third: P = 0.0024). After stratification for quinquennium, tumor staging, according to Cancer of the Liver Italian Program (CLIP), was the only independent predictor of survival (P = 0.015).
  
  
  CONCLUSIONS
  Cirrhotic patients developing a HCC during the last 5 years of surveillance survived longer than previously, as a consequence of improved management of the tumor and complications of cirrhosis.
authors.affiliation: Department of Gastroenterology and Endocirnology, A.M. & A. Migliavacca Center for Liver Diseases, FIRC Unit on Liver Cancer, IRCSS Maggiore Hospital and University of Milan, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Sangiovanni
authors.forename: Ersilio
authors.initials: E
authors.lastname: Del Ninno
authors.forename: Pierangelo
authors.initials: P
authors.lastname: Fasani
authors.forename: Cristina
authors.initials: C
authors.lastname: De Fazio
authors.forename: Guido
authors.initials: G
authors.lastname: Ronchi
authors.forename: Raffaella
authors.initials: R
authors.lastname: Romeo
authors.forename: Alberto
authors.initials: A
authors.lastname: Morabito
authors.forename: Roberto
authors.initials: R
authors.lastname: De Franchis
authors.forename: Massimo
authors.initials: M
authors.lastname: Colombo
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology; D002423:Cause of Death; D005260:Female; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000401:mortality* / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D016019:Survival Analysis