Surveillance of hepatocellular carcinoma in patients with hepatitis C virus infection may improve patient survival.
BACKGROUND
The benefit of surveillance of hepatocellular carcinoma (HCC) for patients with hepatitis C virus (HCV) infection, in terms of long-term survival, has not yet been established.


METHODS
A total of 384 consecutive anti-HCV-positive HCC patients admitted to our hospital between January 1991 and October 2003 were enrolled. Patients were categorized into two groups, a surveillance group (182 patients) and a non-surveillance group (202 patients), according to tumor detection in a surveillance program based on periodical examination via ultrasound sonography and alpha fetoprotein determination at 6-month intervals, and their survival rates were compared.


RESULTS
Although there were no significant differences in age and Child-Pugh classes between the two groups, the surveillance group exhibited a smaller tumor size (19 vs. 35 mm) and a higher incidence of single HCC (67% vs. 46%), compared with the non-surveillance group (each, P < 0.001). The cumulative survival rate in the surveillance group was higher than that in the non-surveillance group (5 years survival, 46% vs. 32%, P < 0.001). When the survival after correction of the lead-time bias in the surveillance group was analyzed according to the Child-Pugh classification, the surveillance program was found to have had a favorable outcome in Child-Pugh class A patients, but not in Child-Pugh class B/C patients.


CONCLUSIONS
HCC surveillance for patients with HCV infection can lead to discovery of tumors at an early stage, especially in Child-Pugh class A, resulting in a favorable outcome.
Tanaka
Hironori
H
Department of Gastroenterology, Hepatology, and Infectious Disease, Okayama University School of Medicine, Okayama, Japan. hironori@tch.or.jp
Nouso
Kazuhiro
K
Kobashi
Haruhiko
H
Kobayashi
Yoshiyuki
Y
Nakamura
Shin-ichiro
S
Miyake
Yasuhiro
Y
Ohnishi
Hideki
H
Miyoshi
Kenji
K
Iwado
Shouta
S
Iwasaki
Yoshiaki
Y
Sakaguchi
Kohsaku
K
Shiratori
Yasushi
Y
D051722:ADAM Proteins / Q000627:therapeutic use; D000072198:ADAM17 Protein; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden
D000970:Antineoplastic Agents; D051722:ADAM Proteins; D000072198:ADAM17 Protein