Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survival

Valentina Santi, Franco Trevisani, Annagiulia Gramenzi, Alice Grignaschi, Federica Mirici-Cappa, Paolo Del Poggio, Maria Anna Di Nolfo, Luisa Benvegn, Fabio Farinati, Marco Zoli, Edoardo Giovanni Giannini, Franco Borzio, Eugenio Caturelli, Maria Chiaramonte, Mauro Bernardi

Research output: Contribution to journalArticlepeer-review


Background & Aims: The current guidelines recommend the surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on liver ultrasonography repetition at either 6 or 12 month intervals, since there is no compelling evidence of superiority of the more stringent program. This study aimed at comparing cancer stage, treatment applicability, and survival between patients on semiannual or annual surveillance. Methods: We analyzed the clinical records of 649 HCC patients in Child-Pugh class A or B, observed in ITA.LI.CA centers. HCC was detected in 510 patients submitted to semiannual surveillance (Group 1) and in 139 submitted to annual surveillance (Group 2). In Group 1 the survival was presented as observed and corrected for the lead time. Results: The cancer stage was less severe in Group 1 than in Group 2 (p <0.001), with more single tiny (≤2 cm) and less advanced tumors. Treatment applicability was improved by the semiannual program (p = 0.020). The median observed survival was 45 months (95% CI 40.0-50.0) in Group 1 and 30 months (95% CI 24.0-36.0) in Group 2 (p = 0.001). The median corrected survival of Group 1 was 40.3 months (95% CI 34.9-45.7) (p = 0.028 with respect to the observed survival of Group 2). Age, platelet count, α-fetoprotein, Child-Pugh class, cancer stage, and hepatocellular carcinoma treatment were independent prognostic factors. Conclusions: Semiannual surveillance increases the detection rate of very early hepatocellular carcinomas and reduces the number of advanced tumors as compared to the annual program. This translates into a greater applicability of effective treatments and into a better prognosis.

Original languageEnglish
Pages (from-to)291-297
Number of pages7
JournalJournal of Hepatology
Issue number2
Publication statusPublished - Aug 2010


  • Cancer stage
  • Cirrhosis
  • Diagnosis
  • Hepatocellular carcinoma
  • Surveillance interval
  • Survival

ASJC Scopus subject areas

  • Hepatology
  • Medicine(all)


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