Does screening or surveillance for primary hepatocellular carcinoma with ultrasonography improve the prognosis of patients?
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.
Yu
Ernest Wen-Ruey
EW
Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Chie
Wei-Chu
WC
Chen
Tony Hsiu-Hsi
TH
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