Can hepatocellular cancer screening increase the proportion of long-term survivors?
OBJECTIVE
Historically, only 10% of hepatocellular cancer (HCC) patients are diagnosed with early stage, potentially curable disease. We prospectively screened chronic hepatitis virus-infected patients to determine 1) the proportion diagnosed with potentially curable HCC, and 2) survival following curative therapy.


METHODS
The study included 5670 chronic hepatitis B (1,077, 19.0%), C (4,196, 74.0%), or both (397, 7.0%)-infected patients enrolled in a prospective screening program. Screening was every 6 months with serum alpha-fetoprotein (AFP) measurement and ultrasonography. Curative treatments included liver transplantation, resection, RFA, and/or ethanol injection.


RESULTS
HCC was diagnosed in 464 (8.2%) patients. Of 1006 cirrhotic patients, 462 (45.9%) developed HCC. Curative treatment was possible in 319 (68.7%). The 2- and 5-year overall survival rates in the curative treatment group were 65% and 28%, respectively, compared to 10% and 0% in the advanced disease group (p < 0.001).


CONCLUSIONS
Prospective screening of patients at high risk to develop HCC increases the proportion diagnosed with potentially curable disease. This may result in an increase of the number of long-term survivors. A screening strategy should focus on those patients with chronic hepatitis B or C virus infection that has progressed to cirrhosis since more than 40% of these patients will develop HCC.
Gannon
Christopher J
CJ
Division of Surgical Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, 195 Little Albany Street, New Brunswick, New Jersey 08903, USA. gannoncj@umdnj.edu
Izzo
Francesco
F
Aloia
Thomas A
TA
Pignata
Sandro
S
Nasti
Guglielmo
G
Vallone
Paolo
P
Orlando
Raffaele
R
Scordino
Fabrizio
F
Curley
Steven A
SA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D016009:Chi-Square Distribution; D019694:Hepatitis B, Chronic / Q000150:complications; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000628:therapy / Q000821:virology; D008403:Mass Screening; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D015996:Survival Rate; D017741:Survivors; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000378:metabolism
D000509:alpha-Fetoproteins