TY - JOUR
T1 - Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survival
AU - Santi, Valentina
AU - Trevisani, Franco
AU - Gramenzi, Annagiulia
AU - Grignaschi, Alice
AU - Mirici-Cappa, Federica
AU - Poggio, Paolo Del
AU - Nolfo, Maria Anna Di
AU - Benvegn, Luisa
AU - Farinati, Fabio
AU - Zoli, Marco
AU - Giannini, Edoardo Giovanni
AU - Borzio, Franco
AU - Caturelli, Eugenio
AU - Chiaramonte, Maria
AU - Bernardi, Mauro
PY - 2010/8
Y1 - 2010/8
N2 - 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.
AB - 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.
KW - Cancer stage
KW - Cirrhosis
KW - Diagnosis
KW - Hepatocellular carcinoma
KW - Surveillance interval
KW - Survival
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U2 - 10.1016/j.jhep.2010.03.010
DO - 10.1016/j.jhep.2010.03.010
M3 - Article
C2 - 20483497
AN - SCOPUS:77955306863
VL - 53
SP - 291
EP - 297
JO - Journal of Hepatology
JF - Journal of Hepatology
SN - 0168-8278
IS - 2
ER -