Abstract
Objective
Liver transplantation has become an effective treatment for cirrhotic patients with
early-stage hepatocellular carcinoma. We hypothesized that the quality of surveillance
for hepatocellular carcinoma influences prognosis by affecting access to liver transplantation.
Methods
A total of 269 patients with cirrhosis and hepatocellular carcinoma were retrospectively
categorized into 3 groups according to quality of surveillance: standard-of-care (n=172) (group 1); substandard surveillance (n=48) (group 2); and absence of surveillance in patients not recognized to be cirrhotic
(n=59) (group 3).
Results
Three-year survival in the 60 patients who underwent liver transplantation was 81%
versus 12% for patients who did not undergo transplantation (P<.001). The percentages of patients who underwent transplantation according to tumor
stage at diagnosis (T1, T2, T3, and T4) were 58%, 35%, 10%, and 1%, respectively.
Hepatocellular carcinoma was diagnosed at stages 1 and 2 in 70% of patients in group
1, 37% of patients in group 2, and only 18% of patients in group 3 (P <.001). Liver transplantation was performed in 32% of patients in group 1, 13% of
patients in group 2, and 7% of patients in group 3 (P<.001). Three-year survival from cancer diagnosis in patients in group 3 (12%) was
significantly worse than in patients in group 1 (39%) or group 2 (27%) (each P <.05). Eighty percent of patients in group 3 had subtle abnormalities of cirrhosis
on routine laboratory tests.
Conclusion
The quality of surveillance has a direct impact on hepatocellular carcinoma stage
at diagnosis, access to liver transplantation, and survival.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hepatocellular carcinoma in Italian patients with cirrhosis.N Engl J Med. 1991; 325: 675-680
- Resection and liver transplantation for hepatocellular carcinoma.Semin Liver Dis. 2005; 25: 181-200
- Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis.N Engl J Med. 1996; 334: 693-699
- Liver transplantation for hepatocellular carcinoma.Gastroenterology. 2005; 128: 1752-1764
- Clinical management of hepatocellular carcinoma.J Hepatol. 2001; 35: 421-430
- Issues in screening and surveillance for hepatocellular carcinoma.Gastroenterology. 2004; 127: S104-S107
- Surveillance for hepatocellular carcinoma.Semin Oncol. 2001; 28: 450-459
- Management of hepatocellular carcinoma.Hepatology. 2005; 42: 1208-1236
- A randomized prospective multi-institutional trial of orthotopic liver transplantation or partial hepatic resection with or without adjuvant chemotherapy for hepatocellular carcinoma.1998
- Semiannual and annual surveillance of cirrhotic patients for hepatocellular carcinoma: effects on cancer stage and patient survival (Italian experience).Am J Gastroenterol. 2002; 97: 734-744
- A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C.Hepatology. 2003; 38: 518-526
- Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection.Hepatology. 2006; 43: 1317-1325
- Resection of hepatocellular carcinomas.Gastroenterology. 1990; 98: 733-738
- Role of liver transplantation in cancer therapy.Ann Surg. 1985; 202: 401-407
- Primary hepatic malignancy: the role of liver transplantation.Br J Surg. 1990; 77: 983-987
- Impact of pretransplant diagnosis of hepatocellular carcinoma on cadaveric liver allocation in the era of MELD.Liver Transpl. 2004; 10: 42-48
- Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis.Hepatology. 2001; 33: 1080-1086
- Liver transplantation for small hepatocellular carcinoma: the tumor-node-metastasis classification does not have prognostic power.Hepatology. 1998; 27: 1572-1577
- Liver transplantation for hepatocellular cancer: the impact of the MELD allocation policy.Gastroenterology. 2004; 127: S261-S267
- Long-term results with multimodal adjuvant therapy and liver transplantation for the treatment of hepatocellular carcinomas larger than 5 centimeters.Ann Surg. 2002; 235: 533-539
- Early detection of hepatocellular carcinoma increases the chance of treatment: Hong Kong experience.Hepatology. 2000; 31: 330-335
- Hepatocellular carcinoma: the role of screening.Asian Pac J Cancer Prev. 2000; 1: 121-126
- Ultrasound screening and risk factors for death from hepatocellular carcinoma in a high risk group in Taiwan.Int J Cancer. 2002; 98: 257-261
- Impact of surveillance on survival of patients with initial hepatocellular carcinoma: a study from Japan.Clin Gastroenterol Hepatol. 2006; 4: 1170-1176
- Prospective study of early detection of hepatocellular carcinoma in patients with cirrhosis.Hepatology. 1990; 12: 680-687
- Randomized controlled trial of screening for hepatocellular carcinoma.J Cancer Res Clin Oncol. 2004; 130: 417-422
- Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis.Gut. 2001; 48: 251-259
- Prospective study of screening for hepatocellular carcinoma in Caucasian patients with cirrhosis.J Hepatol. 1994; 20: 65-71
- Efficacy of a surveillance program for early detection of hepatocellular carcinoma.Cancer. 1996; 78: 977-985
- Growth rate of asymptomatic hepatocellular carcinoma and its clinical implications.Gastroenterology. 1985; 89: 259-266
- Predictors of long-term survival after liver transplantation for hepatocellular carcinoma.Am J Gastroenterol. 2005; 100: 2708-2716
- Resection and liver transplantation for hepatocellular carcinoma.Semin Liver Dis. 2005; 25: 181-200
- Non-resective ablation and liver transplantation in patients with cirrhosis and hepatocellular carcinoma (HCC): safety and efficacy.Am J Transplant. 2003; 3: 312-317
- Silent cirrhosis in patients with hepatocellular carcinoma.Cancer. 1990; 65: 1607-1610
- Validity and clinical utility of the aspartate aminotransferase-alanine aminotransferase ratio in assessing disease severity and prognosis in patients with hepatitis C virus-related chronic liver disease.Arch Intern Med. 2003; 163: 218-224
- A simple approach to noninvasively identifying significant fibrosis in chronic hepatitis C patients in clinical practice.J Clin Gastroenterol. 2006; 40: 521-527
- AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection.Am J Gastroenterol. 1998; 93: 44-48
- FIB-4: a simple, inexpensive and accurate marker of fibrosis in HCV-infected patients.Hepatology. 2006; 44: 769-770
Article info
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
