title: Changing paradigm in the management of hepatocellular carcinoma improves the survival benefit of early detection by screening.
abstract: OBJECTIVE
  To evaluate the impact of improved surgical management of hepatocellular carcinoma (HCC) on the survival of patients with screened HCC.
  
  
  BACKGROUND
  It is unclear whether the advent of new treatment modalities such as liver transplantation and radiofrequency ablation (RFA) in recent years have improved the long-term survival in patients with HCC detected by screening.
  
  
  METHODS
  A prospective database of 1366 patients with known chronic hepatitis B or C virus infection diagnosed with HCC either by screening or symptomatic presentation from January 1991 to December 2004 was reviewed. The long-term survival of HCC patients in the screened and symptomatic groups was compared. The management and survival of patients in two 7-year periods (1991-1997 vs. 1998-2004) were further compared.
  
  
  RESULTS
  Long-term survival was significantly better in the screened group than in the symptomatic group (median survival 61.9 vs. 11.5 months, P < 0.001). The proportion of patients with curative treatment increased from 50.5% in the first period to 67.8% in the second period in the screened group, but there was no significant change in the symptomatic group. Improved long-term survival was observed in patients with HCC detected by screening and treated in the second period compared with the first period (median survival 68.5 vs. 38.7 months, P = 0.022), but no significant improvement was observed for symptomatic patients.
  
  
  CONCLUSIONS
  Survival of patients with HCC detected by screening has improved in recent years due to increased chance of curative treatment with the advent of liver transplantation and RFA.
authors: Department of Surgery, University of Hong Kong Medical Centre, Hong Kong, China.
authors: Albert C Y
authors: AC
authors: Chan
authors: Ronnie T P
authors: RT
authors: Poon
authors: Kelvin K C
authors: KK
authors: Ng
authors: Chung Mau
authors: CM
authors: Lo
authors: Sheung Tat
authors: ST
authors: Fan
authors: John
authors: J
authors: Wong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000628:therapy; D017115:Catheter Ablation; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D018579:Patient Selection; D016019:Survival Analysis