title: Does screening or surveillance for primary hepatocellular carcinoma with ultrasonography improve the prognosis of patients?
abstract: OBJECTIVE
  The purpose of this paper is to evaluate the efficacy of ultrasonographic screening for primary hepatocellular carcinoma.
  
  
  METHODS
  A total of 680 eligible cases were classified into three groups (surveillance, opportunistic, and symptomatic groups) according to their initial exposure. We used survival time, tumor morphology, and T staging as prognostic outcomes. The outcomes of screened/unscreened and sur veillance/nonsur veillance were compared with the use of the logistic regression model.
  
  
  RESULTS
  The adjusted odds ratios for the screened group versus the unscreened group, with 1-, 2-, and 3-year survival time being used as outcomes, were 0.33 (95% confidence interval [CI], 0.21-0.52), 0.33 (95% CI, 0.21-0.53), and 0.37 (95% CI, 0.23-0.61), respectively. The adjusted odds ratios for surveillance versus nonsurveillance were 0.58 (95% CI, 0.35-0.97), 0.45 (95% CI, 0.27-0.74), and 0.44 (95% CI, 0.26-0.73). The odds ratios were even smaller when tumor morphology or T stage was taken as the main outcome. All these results were statistically significant. There were significant gradient relationships between prognostic outcomes and extent of screening history.
  
  
  CONCLUSIONS
  The significant impact of ultrasonographic screening on mortality reduction was demonstrated. These findings strongly suggest that early detection of hepatocellular carcinoma by ultrasound may improve the prognosis of patients with hepatocellular carcinoma.
authors.affiliation: Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Ernest Wen-Ruey
authors.initials: EW
authors.lastname: Yu
authors.forename: Wei-Chu
authors.initials: WC
authors.lastname: Chie
authors.forename: Tony Hsiu-Hsi
authors.initials: TH
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000473:pathology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D011159:Population Surveillance; D011379:Prognosis; D012042:Registries; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D014463:Ultrasonography