Usefulness of surveillance programmes for early diagnosis of hepatocellular carcinoma in clinical practice.
OBJECTIVE
Surveillance programmes (SPs) for hepatocellular carcinoma (HCC) in patients with cirrhosis intend to diagnose the tumour in its early stages when an effective therapy can be applied. The aims of this study have been to compare the survival of patients with HCC being diagnosed or not in SPs, and to establish a more accurate profile of the best target population.


METHODS
From January 1996 to June 2005, 290 patients with HCC were included. The relationship between being diagnosed or not in an SP and survival has been analysed in a univariate analysis. Pretreatment variables found to be significant predictors of survival in univariate analysis were included in a multivariate analysis.


RESULTS
The mean survival for patients diagnosed in SPs (27 months, 16.6-37.4) was significantly longer than in patients being diagnosed out of these programmes (6 months, 2.6-9.4) (P=0.001). Child-Pugh class A [beta 1.4, 95% confidence interval (CI) 1.14-1.78; P=0.0002] and being diagnosed in SPs (beta 0.4, 95% CI 0.3-0.6; P=0.0003) became the only independent predictive factors of longer survival.


CONCLUSIONS
SPs for HCC allow the detection of small tumours and the application of intention-to-cure therapies, which improves survival. However, these programmes do not improve prognosis in patients with advanced cirrhosis.
Pascual
Sonia
S
Liver Unit, Hospital General Universitario de Alicante, Alicante, Spain. pascual_son@gva.es
Irurzun
Javier
J
Zapater
Pedro
P
Such
José
J
Sempere
Laura
L
Carnicer
Fernando
F
Palazón
Jose María
JM
de la Iglesia
Pedro
P
Gil
Santiago
S
de España
Francisco
F
Perez-Mateo
Miguel
M
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D016019:Survival Analysis