Surveillance for early diagnosis of hepatocellular carcinoma: Is it effective in intermediate/advanced cirrhosis?

Franco Trevisani, Valentina Santi, Annagiulia Gramenzi, Maria Anna Di Nolfo, Paolo Del Poggio, Luisa Benvegnù, Gianludovico Rapaccini, Fabio Farinati, Marco Zoli, Franco Borzio, Edoardo Giovanni Giannini, Eugenio Caturelli, Mauro Bernardi

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Abstract

OBJECTIVES: Surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on ultrasonography and alpha-fetoprotein (AFP) measurement, is widely used. Its effectiveness depends on liver function, which affects the feasibility of treatments and cirrhosis-related mortality. We assessed whether patients with intermediate/advanced cirrhosis benefit from surveillance. METHODS: We selected 468 Child-Pugh class B and 140 class C patients from the ITA.LI.CA database, including 1,834 HCC patients diagnosed from January 1987 to December 2004. HCC was detected in 252 patients during surveillance (semiannual 172, annual 80 patients; group 1) and in 356 patients outside surveillance (group 2). Survival of surveyed patients was corrected for the estimated lead time. RESULTS: Child-Pugh class B: cancer stage (P <0.001) and treatment distribution (P <0.001) were better in group 1 than in group 2. The median (95% CI) survivals were 17.1 (13.5-20.6) versus 12.0 (9.4-14.6) months and the survival rates at 1, 3, and 5 yr were 60.4% versus 49.2%, 26.1% versus 16.1%, and 10.7% versus 4.3%, respectively (P = 0.022). AFP, gross pathology, and treatment of HCC were independent prognostic factors. Child-Pugh class C: cancer stage (P = 0.001) and treatment distribution (P = 0.021) were better in group 1 than in group 2. Nonetheless, median survival did not differ: 7.1 (2.1-12.1) versus 6.0 (4.1-7.9) months (P = 0.740). CONCLUSIONS: These results suggest surveillance be offered to class B patients and maintained for class A patients who migrate to the subsequent class. Surveillance becomes pointless in class C patients probably because the poor liver function adversely affects the overall mortality and HCC treatments.

Original languageEnglish
Pages (from-to)2448-2457
Number of pages10
JournalAmerican Journal of Gastroenterology
Volume102
Issue number11
DOIs
Publication statusPublished - Nov 2007

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Early Diagnosis
Hepatocellular Carcinoma
Fibrosis
alpha-Fetoproteins
Survival
Therapeutics
Mortality
Liver
Ultrasonography
Neoplasms
Survival Rate
Databases
Pathology

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Trevisani, F., Santi, V., Gramenzi, A., Di Nolfo, M. A., Poggio, P. D., Benvegnù, L., ... Bernardi, M. (2007). Surveillance for early diagnosis of hepatocellular carcinoma: Is it effective in intermediate/advanced cirrhosis? American Journal of Gastroenterology, 102(11), 2448-2457. https://doi.org/10.1111/j.1572-0241.2007.01395.x

Surveillance for early diagnosis of hepatocellular carcinoma : Is it effective in intermediate/advanced cirrhosis? / Trevisani, Franco; Santi, Valentina; Gramenzi, Annagiulia; Di Nolfo, Maria Anna; Poggio, Paolo Del; Benvegnù, Luisa; Rapaccini, Gianludovico; Farinati, Fabio; Zoli, Marco; Borzio, Franco; Giovanni Giannini, Edoardo; Caturelli, Eugenio; Bernardi, Mauro.

In: American Journal of Gastroenterology, Vol. 102, No. 11, 11.2007, p. 2448-2457.

Research output: Contribution to journalArticle

Trevisani, F, Santi, V, Gramenzi, A, Di Nolfo, MA, Poggio, PD, Benvegnù, L, Rapaccini, G, Farinati, F, Zoli, M, Borzio, F, Giovanni Giannini, E, Caturelli, E & Bernardi, M 2007, 'Surveillance for early diagnosis of hepatocellular carcinoma: Is it effective in intermediate/advanced cirrhosis?', American Journal of Gastroenterology, vol. 102, no. 11, pp. 2448-2457. https://doi.org/10.1111/j.1572-0241.2007.01395.x
Trevisani, Franco ; Santi, Valentina ; Gramenzi, Annagiulia ; Di Nolfo, Maria Anna ; Poggio, Paolo Del ; Benvegnù, Luisa ; Rapaccini, Gianludovico ; Farinati, Fabio ; Zoli, Marco ; Borzio, Franco ; Giovanni Giannini, Edoardo ; Caturelli, Eugenio ; Bernardi, Mauro. / Surveillance for early diagnosis of hepatocellular carcinoma : Is it effective in intermediate/advanced cirrhosis?. In: American Journal of Gastroenterology. 2007 ; Vol. 102, No. 11. pp. 2448-2457.
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abstract = "OBJECTIVES: Surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on ultrasonography and alpha-fetoprotein (AFP) measurement, is widely used. Its effectiveness depends on liver function, which affects the feasibility of treatments and cirrhosis-related mortality. We assessed whether patients with intermediate/advanced cirrhosis benefit from surveillance. METHODS: We selected 468 Child-Pugh class B and 140 class C patients from the ITA.LI.CA database, including 1,834 HCC patients diagnosed from January 1987 to December 2004. HCC was detected in 252 patients during surveillance (semiannual 172, annual 80 patients; group 1) and in 356 patients outside surveillance (group 2). Survival of surveyed patients was corrected for the estimated lead time. RESULTS: Child-Pugh class B: cancer stage (P <0.001) and treatment distribution (P <0.001) were better in group 1 than in group 2. The median (95{\%} CI) survivals were 17.1 (13.5-20.6) versus 12.0 (9.4-14.6) months and the survival rates at 1, 3, and 5 yr were 60.4{\%} versus 49.2{\%}, 26.1{\%} versus 16.1{\%}, and 10.7{\%} versus 4.3{\%}, respectively (P = 0.022). AFP, gross pathology, and treatment of HCC were independent prognostic factors. Child-Pugh class C: cancer stage (P = 0.001) and treatment distribution (P = 0.021) were better in group 1 than in group 2. Nonetheless, median survival did not differ: 7.1 (2.1-12.1) versus 6.0 (4.1-7.9) months (P = 0.740). CONCLUSIONS: These results suggest surveillance be offered to class B patients and maintained for class A patients who migrate to the subsequent class. Surveillance becomes pointless in class C patients probably because the poor liver function adversely affects the overall mortality and HCC treatments.",
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AU - Trevisani, Franco

AU - Santi, Valentina

AU - Gramenzi, Annagiulia

AU - Di Nolfo, Maria Anna

AU - Poggio, Paolo Del

AU - Benvegnù, Luisa

AU - Rapaccini, Gianludovico

AU - Farinati, Fabio

AU - Zoli, Marco

AU - Borzio, Franco

AU - Giovanni Giannini, Edoardo

AU - Caturelli, Eugenio

AU - Bernardi, Mauro

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N2 - OBJECTIVES: Surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on ultrasonography and alpha-fetoprotein (AFP) measurement, is widely used. Its effectiveness depends on liver function, which affects the feasibility of treatments and cirrhosis-related mortality. We assessed whether patients with intermediate/advanced cirrhosis benefit from surveillance. METHODS: We selected 468 Child-Pugh class B and 140 class C patients from the ITA.LI.CA database, including 1,834 HCC patients diagnosed from January 1987 to December 2004. HCC was detected in 252 patients during surveillance (semiannual 172, annual 80 patients; group 1) and in 356 patients outside surveillance (group 2). Survival of surveyed patients was corrected for the estimated lead time. RESULTS: Child-Pugh class B: cancer stage (P <0.001) and treatment distribution (P <0.001) were better in group 1 than in group 2. The median (95% CI) survivals were 17.1 (13.5-20.6) versus 12.0 (9.4-14.6) months and the survival rates at 1, 3, and 5 yr were 60.4% versus 49.2%, 26.1% versus 16.1%, and 10.7% versus 4.3%, respectively (P = 0.022). AFP, gross pathology, and treatment of HCC were independent prognostic factors. Child-Pugh class C: cancer stage (P = 0.001) and treatment distribution (P = 0.021) were better in group 1 than in group 2. Nonetheless, median survival did not differ: 7.1 (2.1-12.1) versus 6.0 (4.1-7.9) months (P = 0.740). CONCLUSIONS: These results suggest surveillance be offered to class B patients and maintained for class A patients who migrate to the subsequent class. Surveillance becomes pointless in class C patients probably because the poor liver function adversely affects the overall mortality and HCC treatments.

AB - OBJECTIVES: Surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on ultrasonography and alpha-fetoprotein (AFP) measurement, is widely used. Its effectiveness depends on liver function, which affects the feasibility of treatments and cirrhosis-related mortality. We assessed whether patients with intermediate/advanced cirrhosis benefit from surveillance. METHODS: We selected 468 Child-Pugh class B and 140 class C patients from the ITA.LI.CA database, including 1,834 HCC patients diagnosed from January 1987 to December 2004. HCC was detected in 252 patients during surveillance (semiannual 172, annual 80 patients; group 1) and in 356 patients outside surveillance (group 2). Survival of surveyed patients was corrected for the estimated lead time. RESULTS: Child-Pugh class B: cancer stage (P <0.001) and treatment distribution (P <0.001) were better in group 1 than in group 2. The median (95% CI) survivals were 17.1 (13.5-20.6) versus 12.0 (9.4-14.6) months and the survival rates at 1, 3, and 5 yr were 60.4% versus 49.2%, 26.1% versus 16.1%, and 10.7% versus 4.3%, respectively (P = 0.022). AFP, gross pathology, and treatment of HCC were independent prognostic factors. Child-Pugh class C: cancer stage (P = 0.001) and treatment distribution (P = 0.021) were better in group 1 than in group 2. Nonetheless, median survival did not differ: 7.1 (2.1-12.1) versus 6.0 (4.1-7.9) months (P = 0.740). CONCLUSIONS: These results suggest surveillance be offered to class B patients and maintained for class A patients who migrate to the subsequent class. Surveillance becomes pointless in class C patients probably because the poor liver function adversely affects the overall mortality and HCC treatments.

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