Identification and screening of 416 patients with chronic hepatitis at high risk to develop hepatocellular cancer

S. A. Curley, F. Izzo, A. Gallipoli, M. De Bellis, F. Cremona, V. Parisi, T. J. Eberlein, T. S. Ravikumar, R. C. Lim, J. M. Daly, D. E. Fry, G. F. Sheldon, J. M. Henderson, M. J. Orloff

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Abstract

Objective: The authors performed a prospective trial to screen patients with chronic hepatitis B or C virus (HBV, HCV) infections to (1) determine the incidence of asymptomatic hepatocellular cancer and (2) identify the subgroups at highest risk to develop hepatocellular cancer. Methods: Four hundred sixteen patients with chronic hepatitis of more than 5 years' duration were evaluated (340 HCV, 69 HBV, 7 both). All underwent hepatic ultrasound and measurement of serum alphafetoprotein every 3 months. Liver biopsy was performed on entry into the study to determine the severity of hepatitis-related liver injury. Results: Initial screening identified asymptomatic hepatocellular cancer in 33 patients (7.9%). Three additional liver cancers were detected during the 1st year of follow-up, bringing the overall incidence to 8.6%. Treatment with curative intent was possible in 22 of these patients (61.1%), whereas 14 (38.9%) had advanced disease. Thirty- five of these hepatocellular cancers occurred in a subset of 140 patients (25% incidence) with liver biopsies showing severe chronic active hepatitis, cirrhosis, or both, and one hepatocellular cancer occurred among the 276 patients (0.4%) with histologically less severe liver injury (p <0.0001, chi square test). Conclusions: This screening study in patients with chronic HBV or HCV infection demonstrates (1) that the yield of asymptomatic hepatocellular cancer on initial screening is 7.9% and (2) that patients with severe chronic active hepatitis, cirrhosis, or both are at extremely high risk to develop hepatocellular cancer (25%). On the basis of these results and the finding of a significant number of small, treatable hepatocellular cancers (61.1%), the authors recommend hepatocellular cancer screening every 3 months for the subset of high-risk patients.

Original languageEnglish
Pages (from-to)375-383
Number of pages9
JournalAnnals of Surgery
Volume222
Issue number3
Publication statusPublished - 1995

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Chronic Hepatitis
Liver Neoplasms
Liver
Incidence
Fibrosis
Biopsy
Chronic Hepatitis B
Wounds and Injuries
Chronic Hepatitis C
Chi-Square Distribution
Infection
Early Detection of Cancer
Hepatitis B virus
Hepacivirus
Hepatitis

ASJC Scopus subject areas

  • Surgery

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Identification and screening of 416 patients with chronic hepatitis at high risk to develop hepatocellular cancer. / Curley, S. A.; Izzo, F.; Gallipoli, A.; De Bellis, M.; Cremona, F.; Parisi, V.; Eberlein, T. J.; Ravikumar, T. S.; Lim, R. C.; Daly, J. M.; Fry, D. E.; Sheldon, G. F.; Henderson, J. M.; Orloff, M. J.

In: Annals of Surgery, Vol. 222, No. 3, 1995, p. 375-383.

Research output: Contribution to journalArticle

Curley, SA, Izzo, F, Gallipoli, A, De Bellis, M, Cremona, F, Parisi, V, Eberlein, TJ, Ravikumar, TS, Lim, RC, Daly, JM, Fry, DE, Sheldon, GF, Henderson, JM & Orloff, MJ 1995, 'Identification and screening of 416 patients with chronic hepatitis at high risk to develop hepatocellular cancer', Annals of Surgery, vol. 222, no. 3, pp. 375-383.
Curley, S. A. ; Izzo, F. ; Gallipoli, A. ; De Bellis, M. ; Cremona, F. ; Parisi, V. ; Eberlein, T. J. ; Ravikumar, T. S. ; Lim, R. C. ; Daly, J. M. ; Fry, D. E. ; Sheldon, G. F. ; Henderson, J. M. ; Orloff, M. J. / Identification and screening of 416 patients with chronic hepatitis at high risk to develop hepatocellular cancer. In: Annals of Surgery. 1995 ; Vol. 222, No. 3. pp. 375-383.
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abstract = "Objective: The authors performed a prospective trial to screen patients with chronic hepatitis B or C virus (HBV, HCV) infections to (1) determine the incidence of asymptomatic hepatocellular cancer and (2) identify the subgroups at highest risk to develop hepatocellular cancer. Methods: Four hundred sixteen patients with chronic hepatitis of more than 5 years' duration were evaluated (340 HCV, 69 HBV, 7 both). All underwent hepatic ultrasound and measurement of serum alphafetoprotein every 3 months. Liver biopsy was performed on entry into the study to determine the severity of hepatitis-related liver injury. Results: Initial screening identified asymptomatic hepatocellular cancer in 33 patients (7.9{\%}). Three additional liver cancers were detected during the 1st year of follow-up, bringing the overall incidence to 8.6{\%}. Treatment with curative intent was possible in 22 of these patients (61.1{\%}), whereas 14 (38.9{\%}) had advanced disease. Thirty- five of these hepatocellular cancers occurred in a subset of 140 patients (25{\%} incidence) with liver biopsies showing severe chronic active hepatitis, cirrhosis, or both, and one hepatocellular cancer occurred among the 276 patients (0.4{\%}) with histologically less severe liver injury (p <0.0001, chi square test). Conclusions: This screening study in patients with chronic HBV or HCV infection demonstrates (1) that the yield of asymptomatic hepatocellular cancer on initial screening is 7.9{\%} and (2) that patients with severe chronic active hepatitis, cirrhosis, or both are at extremely high risk to develop hepatocellular cancer (25{\%}). On the basis of these results and the finding of a significant number of small, treatable hepatocellular cancers (61.1{\%}), the authors recommend hepatocellular cancer screening every 3 months for the subset of high-risk patients.",
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T1 - Identification and screening of 416 patients with chronic hepatitis at high risk to develop hepatocellular cancer

AU - Curley, S. A.

AU - Izzo, F.

AU - Gallipoli, A.

AU - De Bellis, M.

AU - Cremona, F.

AU - Parisi, V.

AU - Eberlein, T. J.

AU - Ravikumar, T. S.

AU - Lim, R. C.

AU - Daly, J. M.

AU - Fry, D. E.

AU - Sheldon, G. F.

AU - Henderson, J. M.

AU - Orloff, M. J.

PY - 1995

Y1 - 1995

N2 - Objective: The authors performed a prospective trial to screen patients with chronic hepatitis B or C virus (HBV, HCV) infections to (1) determine the incidence of asymptomatic hepatocellular cancer and (2) identify the subgroups at highest risk to develop hepatocellular cancer. Methods: Four hundred sixteen patients with chronic hepatitis of more than 5 years' duration were evaluated (340 HCV, 69 HBV, 7 both). All underwent hepatic ultrasound and measurement of serum alphafetoprotein every 3 months. Liver biopsy was performed on entry into the study to determine the severity of hepatitis-related liver injury. Results: Initial screening identified asymptomatic hepatocellular cancer in 33 patients (7.9%). Three additional liver cancers were detected during the 1st year of follow-up, bringing the overall incidence to 8.6%. Treatment with curative intent was possible in 22 of these patients (61.1%), whereas 14 (38.9%) had advanced disease. Thirty- five of these hepatocellular cancers occurred in a subset of 140 patients (25% incidence) with liver biopsies showing severe chronic active hepatitis, cirrhosis, or both, and one hepatocellular cancer occurred among the 276 patients (0.4%) with histologically less severe liver injury (p <0.0001, chi square test). Conclusions: This screening study in patients with chronic HBV or HCV infection demonstrates (1) that the yield of asymptomatic hepatocellular cancer on initial screening is 7.9% and (2) that patients with severe chronic active hepatitis, cirrhosis, or both are at extremely high risk to develop hepatocellular cancer (25%). On the basis of these results and the finding of a significant number of small, treatable hepatocellular cancers (61.1%), the authors recommend hepatocellular cancer screening every 3 months for the subset of high-risk patients.

AB - Objective: The authors performed a prospective trial to screen patients with chronic hepatitis B or C virus (HBV, HCV) infections to (1) determine the incidence of asymptomatic hepatocellular cancer and (2) identify the subgroups at highest risk to develop hepatocellular cancer. Methods: Four hundred sixteen patients with chronic hepatitis of more than 5 years' duration were evaluated (340 HCV, 69 HBV, 7 both). All underwent hepatic ultrasound and measurement of serum alphafetoprotein every 3 months. Liver biopsy was performed on entry into the study to determine the severity of hepatitis-related liver injury. Results: Initial screening identified asymptomatic hepatocellular cancer in 33 patients (7.9%). Three additional liver cancers were detected during the 1st year of follow-up, bringing the overall incidence to 8.6%. Treatment with curative intent was possible in 22 of these patients (61.1%), whereas 14 (38.9%) had advanced disease. Thirty- five of these hepatocellular cancers occurred in a subset of 140 patients (25% incidence) with liver biopsies showing severe chronic active hepatitis, cirrhosis, or both, and one hepatocellular cancer occurred among the 276 patients (0.4%) with histologically less severe liver injury (p <0.0001, chi square test). Conclusions: This screening study in patients with chronic HBV or HCV infection demonstrates (1) that the yield of asymptomatic hepatocellular cancer on initial screening is 7.9% and (2) that patients with severe chronic active hepatitis, cirrhosis, or both are at extremely high risk to develop hepatocellular cancer (25%). On the basis of these results and the finding of a significant number of small, treatable hepatocellular cancers (61.1%), the authors recommend hepatocellular cancer screening every 3 months for the subset of high-risk patients.

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