Optimal treatment increased survival of hepatocellular carcinoma patients detected with community-based screening.
OBJECTIVE
The early detection of hepatocellular carcinoma (HCC) and opportunity to select appropriate treatment are important benefits of HCC screening. Our aim in the present study was to investigate the survival rate, prognostic factors and treatment effects in HCC patients of community-based screening.


METHODS
Community-based ultrasound (US) screening for HCC in adults with platelet counts (< 150 x 10(3)/mm(3)) and/or alpha fetoprotein (AFP) > 20 ng/mL was conducted in 2002 and 2004. As per the Barcelona Clinic Liver Cancer (BCLC) stage, 90 cases of intermediate or earlier stage HCC were detected and 88 cases had sufficient information for analysis (49 men and 39 women, aged 65.8 +/- 9.6 years). The tumor diameter was mostly less than 5 cm (76.1%). The follow up was continued until June 2008.


RESULTS
The 4-year overall survival rate was 46.8%. Old age (> or = 70 years) (P = 0.046), later stage of HCC (intermediate vs earlier) (P = 0.012), low platelet count (< 100 x 10(3)/mm(3)) (P = 0.013) and refusal of modern treatment (P = 0.026) were independent poor prognostic factors. Curative treatment increased survival in patients of all ages. Both curative treatment and transcatheter arterial embolization (TAE) increased survival in cases of intermediate HCC. However, treatment benefits were not found for patients with (very) early stage HCC.


CONCLUSIONS
Early detection and prompt treatment of HCC leads to increased survival. For elderly patients this benefit was seen only for early stage cases receiving curative treatment. Differences between treatment types for patients with (very) early stage HCC might emerge with a longer follow-up period.
Tseng
Po-Lin
PL
Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Tainan.
Wang
Jing-Houng
JH
Tung
Hung-Da
HD
Hung
Chao-Hung
CH
Kee
Kwong-Ming
KM
Chen
Chien-Hung
CH
Chang
Kuo-Chin
KC
Lee
Chuan-Mo
CM
Changchien
Chi-Sin
CS
Chen
Pao-Fei
PF
Tsai
Lin-San
LS
Lu
Sheng-Nan
SN
D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017115:Catheter Ablation / Q000401:mortality; D003153:Community Health Services; D055088:Early Detection of Cancer; D004621:Embolization, Therapeutic / Q000401:mortality; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000401:mortality; D008875:Middle Aged; D009367:Neoplasm Staging; D010976:Platelet Count; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis
C097353:AFP protein, human; D000509:alpha-Fetoproteins; D000431:Ethanol