title: Optimal treatment increased survival of hepatocellular carcinoma patients detected with community-based screening.
abstract: 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.
authors.affiliation: Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Tainan.
authors.forename: Po-Lin
authors.initials: PL
authors.lastname: Tseng
authors.forename: Jing-Houng
authors.initials: JH
authors.lastname: Wang
authors.forename: Hung-Da
authors.initials: HD
authors.lastname: Tung
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Hung
authors.forename: Kwong-Ming
authors.initials: KM
authors.lastname: Kee
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Chang
authors.forename: Chuan-Mo
authors.initials: CM
authors.lastname: Lee
authors.forename: Chi-Sin
authors.initials: CS
authors.lastname: Changchien
authors.forename: Pao-Fei
authors.initials: PF
authors.lastname: Chen
authors.forename: Lin-San
authors.initials: LS
authors.lastname: Tsai
authors.forename: Sheng-Nan
authors.initials: SN
authors.lastname: Lu
mesh_terms: 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
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins; D000431:Ethanol