An intensive surveillance program detected a high incidence of hepatocellular carcinoma among hepatitis B virus carriers with abnormal alpha-fetoprotein levels or abdominal ultrasonography results.
OBJECTIVE
To study the incidence and treatment outcomes of hepatocellular carcinoma (HCC) detected in an intensive surveillance program (ISP) of hepatitis B virus (HBV) carriers.


METHODS
We screened 1,018 HBV carriers by serum alpha-fetoprotein (AFP) measurement and abdominal ultrasonography (AUS). Patients with an abnormal AFP level or AUS result were enrolled in an ISP that included Lipiodol computed tomography followed by AFP measurement/AUS every 3 months for 2 years and then every 6 months thereafter. The rest were on routine surveillance for 2 years.


RESULTS
A total of 9,849 serum AFP measurements and 3,053 AUSs were performed. After a median follow-up of 4.12 years, we diagnosed 24 HCCs among 78 patients with abnormal screening test results at enrollment (group A); 23 HCCs among 93 patients with only abnormal surveillance test results during follow-up (group B); and nine HCCs among 847 patients with 2 years of normal surveillance (group C). Annual incidence of HCC in the ISP was 760.2 (95% CI, 538.4 to 1,073.7) per 100,000. Mean tumor sizes were 3.02, 2.91, and 4.82 cm in groups A, B, and C, respectively (P = .01). Tumor resection rate of the ISP was 36.2%, although another 29.8% of the patients were eligible for locoregional ablative therapy.


CONCLUSIONS
This study illustrated that a high incidence of relatively small HCCs may be detected by using intensive surveillance of high-risk HBV carriers. However, the surgical resection rate was low, and we were not able to demonstrate clinical benefit with the early detection. Future surveillance studies should consider incorporation of therapy aimed at long-term control of small-sized tumors.
Mok
Tony S K
TS
Department of Clinical Oncology, Prince of Wales Hospital, School of Public Health, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China. mok206551@cuhk.edu.hk
Yeo
Winnie
W
Yu
Simon
S
Lai
Paul
P
Chan
Henry L Y
HL
Chan
Anthony T C
AT
Lau
Joseph W Y
JW
Wong
Herman
H
Leung
Nancy
N
Hui
Edwin P
EP
Sung
Joseph
J
Koh
Jane
J
Mo
Frankie
F
Zee
Benny
B
Johnson
Philip J
PJ
D000005:Abdomen / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000000981:diagnostic imaging* / Q000821:virology; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000000981:diagnostic imaging* / Q000821:virology; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000472:pathogenicity*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015996:Survival Rate; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000378:metabolism*
D006514:Hepatitis B Surface Antigens; D000509:alpha-Fetoproteins