title: Surveillance for hepatocellular carcinoma in a mixed-aetiology UK cohort with cirrhosis: does α-fetoprotein still have a role?
abstract: Mortality from hepatocellular carcinoma (HCC) in people with cirrhosis is increasing whereas mortality from other causes is declining. Surveillance appears to reduce mortality but the optimal strategy is uncertain. Current guidelines differ by recommending ultrasonography alone or with α-fetoprotein (αFP). Records in three UK hospitals were analysed from 2006 to 2011. Of 111 HCC cases identified, 24 (47.1%) of those eligible were under surveillance: 21 (87.5%) were under combined ultrasonography-αFP, 2 (8.3%) ultrasonography-only and 1 (4.2%) αFP-only surveillance. αFP was elevated in 19 (86.4%), and αFP alone triggered a confirmatory study in 11 (9.9%) overall and 7 (29.1%) under surveillance. Surveillance, but not αFP, correlated with smaller tumours. Survival did not differ significantly between groups. Given that αFP use is associated with identifying smaller HCCs and that several diagnoses would have been delayed without αFP in this real-life cohort, these data support ongoing αFP use. However, further work is necessary with regard to whether αFP translates into improved clinical outcome and overall cost effects. In our area, stopping αFP use would also represent a significant change in practice.
authors.affiliation: Department of Gastroenterology, Wycombe Hospital, High Wycombe, UK, and Centre for Liver Research, Institute of Biomedical Research, University of Birmingham, Birmingham, UK;
authors.forename: Gwilym J
authors.initials: GJ
authors.lastname: Webb
authors.affiliation: Department of Gastroenterology, John Radcliffe Hospital, Oxford, UK;
authors.forename: Kathryn Vc
authors.initials: KV
authors.lastname: Wright
authors.affiliation: Department of Gastroenterology, Royal Berkshire Hospital, Reading, UK;
authors.forename: Elizabeth Cb
authors.initials: EC
authors.lastname: Harrod
authors.affiliation: Department of Gastroenterology, Wycombe Hospital, UK;
authors.forename: David A
authors.initials: DA
authors.lastname: Gorard
authors.affiliation: Department of Gastroenterology, John Radcliffe Hospital, UK;
authors.forename: Jane D
authors.initials: JD
authors.lastname: Collier
authors.affiliation: Department of Gastroenterology, Royal Berkshire Hospital, UK alex.evans@royalberkshire.nhs.uk.
authors.forename: Alexander Kc
authors.initials: AK
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins
keywords: Hepatocellular carcinoma; ultrasonography; αFP
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