title: Tumor markers are more useful in patients undergoing surveillance for hepatocellular carcinoma with unreliable results by ultrasonography.
abstract: OBJECTIVE
  The objectives of this study was to evaluate the utility of tumor markers in hepatocellular carcinoma (HCC) surveillance based on the reliability of ultrasonography.
  
  
  METHODS
  We analyzed 313 patients with HCC detected through a surveillance program using ultrasonography combined with three tumor markers from February 2000 to December 2010. The patients were categorized into two groups based on the triggering event: the US group (n = 281) in which a tumor was first detected using ultrasonography and the TM group (n = 32) in which elevated tumor markers led to the diagnosis of a tumor that was undetected using ultrasonography. The reliability of ultrasonography was scored on a 4-point scale based on three items (coarseness of liver parenchyma, patient obesity and liver atrophy). Additionally, patient survival was assessed using the Kaplan-Meier method and log-rank test.
  
  
  RESULTS
  The median tumor size was 20 mm (interquartile range, 15-24). The reliability of ultrasonography was evaluated as good in 208 (66.5%), satisfactory in 80 (8.0%), poor in 21 (6.7%) and unsatisfactory in four (1.2%) patients. The proportion of patients in the TM group increased significantly according to the score, from 7.2% to 25.0% (P = 0.01). The survival rates of patients at 3 and 5 years were 83.7% and 57.2% in the US group, and 79.3% and 59.4% in the TM group, respectively (P = 0.98).
  
  
  CONCLUSIONS
  Tumor markers may play a diagnostic role in patients with unreliable ultrasonography results. The survival of patients diagnosed by elevated tumor markers was not significantly different from those diagnosed by ultrasonography.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Mikami
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tateishi
authors.forename: Shu
authors.initials: S
authors.lastname: Hagiwara
authors.forename: Masaya
authors.initials: M
authors.lastname: Sato
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Minami
authors.forename: Koji
authors.initials: K
authors.lastname: Uchino
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Enooku
authors.forename: Takahisa
authors.initials: T
authors.lastname: Sato
authors.forename: Hayato
authors.initials: H
authors.lastname: Nakagawa
authors.forename: Ryota
authors.initials: R
authors.lastname: Masuzaki
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Asaoka
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kondo
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Shiina
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ikeda
authors.forename: Masao
authors.initials: M
authors.lastname: Omata
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Yoshida
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
keywords: hepatocellular carcinoma; surveillance; tumor marker; ultrasonography