title: Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survival.
abstract: 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.
authors.affiliation: Dipartimento di Medicina Clinica, Unità di Semeiotica Medica, Alma Mater Studiorum - Università di Bologna, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Santi
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
authors.forename: Annagiulia
authors.initials: A
authors.lastname: Gramenzi
authors.forename: Alice
authors.initials: A
authors.lastname: Grignaschi
authors.forename: Federica
authors.initials: F
authors.lastname: Mirici-Cappa
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Poggio
authors.forename: Maria Anna
authors.initials: MA
authors.lastname: Di Nolfo
authors.forename: Luisa
authors.initials: L
authors.lastname: Benvegnù
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.forename: Edoardo Giovanni
authors.initials: EG
authors.lastname: Giannini
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.forename: Maria
authors.initials: M
authors.lastname: Chiaramonte
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
mesh_terms: 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