Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survival.
OBJECTIVE
The current guidelines recommend the surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on liver ultrasonography repetition at either 6 or 12 month intervals, since there is no compelling evidence of superiority of the more stringent program. This study aimed at comparing cancer stage, treatment applicability, and survival between patients on semiannual or annual surveillance.


METHODS
We analyzed the clinical records of 649 HCC patients in Child-Pugh class A or B, observed in ITA.LI.CA centers. HCC was detected in 510 patients submitted to semiannual surveillance (Group 1) and in 139 submitted to annual surveillance (Group 2). In Group 1 the survival was presented as observed and corrected for the lead time.


RESULTS
The cancer stage was less severe in Group 1 than in Group 2 (p<0.001), with more single tiny (2 cm) and less advanced tumors. Treatment applicability was improved by the semiannual program (p=0.020). The median observed survival was 45 months (95% CI 40.0-50.0) in Group 1 and 30 months (95% CI 24.0-36.0) in Group 2 (p=0.001). The median corrected survival of Group 1 was 40.3 months (95% CI 34.9-45.7) (p=0.028 with respect to the observed survival of Group 2). Age, platelet count, alpha-fetoprotein, Child-Pugh class, cancer stage, and hepatocellular carcinoma treatment were independent prognostic factors.


CONCLUSIONS
Semiannual surveillance increases the detection rate of very early hepatocellular carcinomas and reduces the number of advanced tumors as compared to the annual program. This translates into a greater applicability of effective treatments and into a better prognosis.
Santi
Valentina
V
Dipartimento di Medicina Clinica, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Italy.
Trevisani
Franco
F
Gramenzi
Annagiulia
A
Grignaschi
Alice
A
Mirici-Cappa
Federica
F
Del Poggio
Paolo
P
Di Nolfo
Maria Anna
MA
Benvegnù
Luisa
L
Farinati
Fabio
F
Zoli
Marco
M
Giannini
Edoardo Giovanni
EG
Borzio
Franco
F
Caturelli
Eugenio
E
Chiaramonte
Maria
M
Bernardi
Mauro
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007558:Italy; D008099:Liver / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D011379:Prognosis; D015996:Survival Rate; D014463:Ultrasonography