Outcome of 67 patients with hepatocellular cancer detected during screening of 1125 patients with chronic hepatitis

Francesco Izzo, Francesco Cremona, Fulvio Ruffolo, Raffaéle Palaia, Valerio Parisi, Steven A. Curley

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Abstract

Objective: We performed this prospective screening trial in chronic hepatitis virus-infected patients to determine the incidence of hepatocellular cancer (HCC) and the resectability and longterm survival rates of these HCC patients. Summary Background Data: Chronic hepatitis B or C virus infection is a major etiologic factor in human HCC. It is not clear if routine screening of chronic vital hepatitis patients improves the survival of patients who develop HCC. Methods: Screening for HCC was offered to patients chronically seropositive (>5 years) for hepatitis B or C infection. All patients underwent percutaneous core liver biopsy to assess the histologic severity of chronic liver injury. Patients were screened initially and every 3 months thereafter with serum alpha-feto-protein and transabdominal ultrasound evaluations; HCC was confirmed by needle biopsy of liver tumors. Results: Screening was performed on 1125 hepatitis-positive patients (804 with hepatitis C, 290 with hepatitis B, 31 with both). On liver biopsy, 800 patients had mild chronic active hepatitis and 325 had severe chronic active hepatitis, cirrhosis, or both Initial screening detected HCC in 61 patients. HCC was detected in six more patients during follow-up; thus, the incidence of HCC was 5.9% (67/1125). However, 66 of the 67 HCC cases (98.5%) arose in the 325 patients with severe chronic active hepatitis or cirrhosis (66/325 [20.3%] vs. 1/800 [0.1%], p <0.0001 [Wilcoxon signed rank]). Median follow-up of the 67 HCC patients was 24 months. Locally advanced or metastatic, unresectable HCC occurred in 43 patients (64.2%); 24 patients (35.8%), including the 6 patients detected during follow-up screening, underwent margin-negative resection. The median survival for the 24 resected patients was 26 months, compared to 6 months for the 43 patients with unresectable cancer (p <0.0001, Wilcoxon signed rank). Conclusions: HCC was found to arise in 20.3% of patients with chronic hepatitis B or C infection and severe liver injury. Initial screening detected resectable lesions in less than half the HCC patients. Routine screening of chronic hepatitis B or C virus-infected patients with ultrasound and alpha- fetoprotein determination should be reserved for patients with severe chronic active hepatitis, cirrhosis, or both.

Original languageEnglish
Pages (from-to)513-518
Number of pages6
JournalAnnals of Surgery
Volume227
Issue number4
DOIs
Publication statusPublished - Apr 1998

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Chronic Hepatitis
Liver Neoplasms
Chronic Hepatitis B
Chronic Hepatitis C
Liver
Fibrosis
Hepatitis C
Hepatitis B
Hepatitis B virus
Hepacivirus
Biopsy
Hepatitis Viruses
Survival

ASJC Scopus subject areas

  • Surgery

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Outcome of 67 patients with hepatocellular cancer detected during screening of 1125 patients with chronic hepatitis. / Izzo, Francesco; Cremona, Francesco; Ruffolo, Fulvio; Palaia, Raffaéle; Parisi, Valerio; Curley, Steven A.

In: Annals of Surgery, Vol. 227, No. 4, 04.1998, p. 513-518.

Research output: Contribution to journalArticle

Izzo, Francesco ; Cremona, Francesco ; Ruffolo, Fulvio ; Palaia, Raffaéle ; Parisi, Valerio ; Curley, Steven A. / Outcome of 67 patients with hepatocellular cancer detected during screening of 1125 patients with chronic hepatitis. In: Annals of Surgery. 1998 ; Vol. 227, No. 4. pp. 513-518.
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title = "Outcome of 67 patients with hepatocellular cancer detected during screening of 1125 patients with chronic hepatitis",
abstract = "Objective: We performed this prospective screening trial in chronic hepatitis virus-infected patients to determine the incidence of hepatocellular cancer (HCC) and the resectability and longterm survival rates of these HCC patients. Summary Background Data: Chronic hepatitis B or C virus infection is a major etiologic factor in human HCC. It is not clear if routine screening of chronic vital hepatitis patients improves the survival of patients who develop HCC. Methods: Screening for HCC was offered to patients chronically seropositive (>5 years) for hepatitis B or C infection. All patients underwent percutaneous core liver biopsy to assess the histologic severity of chronic liver injury. Patients were screened initially and every 3 months thereafter with serum alpha-feto-protein and transabdominal ultrasound evaluations; HCC was confirmed by needle biopsy of liver tumors. Results: Screening was performed on 1125 hepatitis-positive patients (804 with hepatitis C, 290 with hepatitis B, 31 with both). On liver biopsy, 800 patients had mild chronic active hepatitis and 325 had severe chronic active hepatitis, cirrhosis, or both Initial screening detected HCC in 61 patients. HCC was detected in six more patients during follow-up; thus, the incidence of HCC was 5.9{\%} (67/1125). However, 66 of the 67 HCC cases (98.5{\%}) arose in the 325 patients with severe chronic active hepatitis or cirrhosis (66/325 [20.3{\%}] vs. 1/800 [0.1{\%}], p <0.0001 [Wilcoxon signed rank]). Median follow-up of the 67 HCC patients was 24 months. Locally advanced or metastatic, unresectable HCC occurred in 43 patients (64.2{\%}); 24 patients (35.8{\%}), including the 6 patients detected during follow-up screening, underwent margin-negative resection. The median survival for the 24 resected patients was 26 months, compared to 6 months for the 43 patients with unresectable cancer (p <0.0001, Wilcoxon signed rank). Conclusions: HCC was found to arise in 20.3{\%} of patients with chronic hepatitis B or C infection and severe liver injury. Initial screening detected resectable lesions in less than half the HCC patients. Routine screening of chronic hepatitis B or C virus-infected patients with ultrasound and alpha- fetoprotein determination should be reserved for patients with severe chronic active hepatitis, cirrhosis, or both.",
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T1 - Outcome of 67 patients with hepatocellular cancer detected during screening of 1125 patients with chronic hepatitis

AU - Izzo, Francesco

AU - Cremona, Francesco

AU - Ruffolo, Fulvio

AU - Palaia, Raffaéle

AU - Parisi, Valerio

AU - Curley, Steven A.

PY - 1998/4

Y1 - 1998/4

N2 - Objective: We performed this prospective screening trial in chronic hepatitis virus-infected patients to determine the incidence of hepatocellular cancer (HCC) and the resectability and longterm survival rates of these HCC patients. Summary Background Data: Chronic hepatitis B or C virus infection is a major etiologic factor in human HCC. It is not clear if routine screening of chronic vital hepatitis patients improves the survival of patients who develop HCC. Methods: Screening for HCC was offered to patients chronically seropositive (>5 years) for hepatitis B or C infection. All patients underwent percutaneous core liver biopsy to assess the histologic severity of chronic liver injury. Patients were screened initially and every 3 months thereafter with serum alpha-feto-protein and transabdominal ultrasound evaluations; HCC was confirmed by needle biopsy of liver tumors. Results: Screening was performed on 1125 hepatitis-positive patients (804 with hepatitis C, 290 with hepatitis B, 31 with both). On liver biopsy, 800 patients had mild chronic active hepatitis and 325 had severe chronic active hepatitis, cirrhosis, or both Initial screening detected HCC in 61 patients. HCC was detected in six more patients during follow-up; thus, the incidence of HCC was 5.9% (67/1125). However, 66 of the 67 HCC cases (98.5%) arose in the 325 patients with severe chronic active hepatitis or cirrhosis (66/325 [20.3%] vs. 1/800 [0.1%], p <0.0001 [Wilcoxon signed rank]). Median follow-up of the 67 HCC patients was 24 months. Locally advanced or metastatic, unresectable HCC occurred in 43 patients (64.2%); 24 patients (35.8%), including the 6 patients detected during follow-up screening, underwent margin-negative resection. The median survival for the 24 resected patients was 26 months, compared to 6 months for the 43 patients with unresectable cancer (p <0.0001, Wilcoxon signed rank). Conclusions: HCC was found to arise in 20.3% of patients with chronic hepatitis B or C infection and severe liver injury. Initial screening detected resectable lesions in less than half the HCC patients. Routine screening of chronic hepatitis B or C virus-infected patients with ultrasound and alpha- fetoprotein determination should be reserved for patients with severe chronic active hepatitis, cirrhosis, or both.

AB - Objective: We performed this prospective screening trial in chronic hepatitis virus-infected patients to determine the incidence of hepatocellular cancer (HCC) and the resectability and longterm survival rates of these HCC patients. Summary Background Data: Chronic hepatitis B or C virus infection is a major etiologic factor in human HCC. It is not clear if routine screening of chronic vital hepatitis patients improves the survival of patients who develop HCC. Methods: Screening for HCC was offered to patients chronically seropositive (>5 years) for hepatitis B or C infection. All patients underwent percutaneous core liver biopsy to assess the histologic severity of chronic liver injury. Patients were screened initially and every 3 months thereafter with serum alpha-feto-protein and transabdominal ultrasound evaluations; HCC was confirmed by needle biopsy of liver tumors. Results: Screening was performed on 1125 hepatitis-positive patients (804 with hepatitis C, 290 with hepatitis B, 31 with both). On liver biopsy, 800 patients had mild chronic active hepatitis and 325 had severe chronic active hepatitis, cirrhosis, or both Initial screening detected HCC in 61 patients. HCC was detected in six more patients during follow-up; thus, the incidence of HCC was 5.9% (67/1125). However, 66 of the 67 HCC cases (98.5%) arose in the 325 patients with severe chronic active hepatitis or cirrhosis (66/325 [20.3%] vs. 1/800 [0.1%], p <0.0001 [Wilcoxon signed rank]). Median follow-up of the 67 HCC patients was 24 months. Locally advanced or metastatic, unresectable HCC occurred in 43 patients (64.2%); 24 patients (35.8%), including the 6 patients detected during follow-up screening, underwent margin-negative resection. The median survival for the 24 resected patients was 26 months, compared to 6 months for the 43 patients with unresectable cancer (p <0.0001, Wilcoxon signed rank). Conclusions: HCC was found to arise in 20.3% of patients with chronic hepatitis B or C infection and severe liver injury. Initial screening detected resectable lesions in less than half the HCC patients. Routine screening of chronic hepatitis B or C virus-infected patients with ultrasound and alpha- fetoprotein determination should be reserved for patients with severe chronic active hepatitis, cirrhosis, or both.

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