title: Surveillance for hepatocellular carcinoma in patients with cirrhosis improves outcome.
abstract: OBJECTIVE
  Liver transplantation has become an effective treatment for cirrhotic patients with early-stage hepatocellular carcinoma. We hypothesized that the quality of surveillance for hepatocellular carcinoma influences prognosis by affecting access to liver transplantation.
  
  
  METHODS
  A total of 269 patients with cirrhosis and hepatocellular carcinoma were retrospectively categorized into 3 groups according to quality of surveillance: standard-of-care (n=172) (group 1); substandard surveillance (n=48) (group 2); and absence of surveillance in patients not recognized to be cirrhotic (n=59) (group 3).
  
  
  RESULTS
  Three-year survival in the 60 patients who underwent liver transplantation was 81% versus 12% for patients who did not undergo transplantation (P<.001). The percentages of patients who underwent transplantation according to tumor stage at diagnosis (T1, T2, T3, and T4) were 58%, 35%, 10%, and 1%, respectively. Hepatocellular carcinoma was diagnosed at stages 1 and 2 in 70% of patients in group 1, 37% of patients in group 2, and only 18% of patients in group 3 (P <.001). Liver transplantation was performed in 32% of patients in group 1, 13% of patients in group 2, and 7% of patients in group 3 (P<.001). Three-year survival from cancer diagnosis in patients in group 3 (12%) was significantly worse than in patients in group 1 (39%) or group 2 (27%) (each P<.05). Eighty percent of patients in group 3 had subtle abnormalities of cirrhosis on routine laboratory tests.
  
  
  CONCLUSIONS
  The quality of surveillance has a direct impact on hepatocellular carcinoma stage at diagnosis, access to liver transplantation, and survival.
authors.affiliation: Section of Hepatology, Hume-Lee Transplant Center of Virginia Commonwealth University, Richmond, VA 23298-0341, USA. rstravit@hsc.vcu.edu
authors.forename: Richard Todd
authors.initials: RT
authors.lastname: Stravitz
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Heuman
authors.forename: Nisha
authors.initials: N
authors.lastname: Chand
authors.forename: Richard K
authors.initials: RK
authors.lastname: Sterling
authors.forename: Mitchell L
authors.initials: ML
authors.lastname: Shiffman
authors.forename: Velimir A
authors.initials: VA
authors.lastname: Luketic
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: Adil
authors.initials: A
authors.lastname: Habib
authors.forename: Anastasios A
authors.initials: AA
authors.lastname: Mihas
authors.forename: Ho-Chong S
authors.initials: HC
authors.lastname: Giles
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Maluf
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Cotterell
authors.forename: Marc P
authors.initials: MP
authors.lastname: Posner
authors.forename: Robert A
authors.initials: RA
authors.lastname: Fisher
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology*; D016031:Liver Transplantation; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D011787:Quality of Health Care; D012189:Retrospective Studies