Pitfalls in surveillance for hepatocellular carcinoma: How successful is it in the real world?
Clinical and Molecular Hepatology
; : 239-248, 2017.
Article
in En
| WPRIM
| ID: wpr-219270
Responsible library:
WPRO
ABSTRACT
BACKGROUND/AIMS:
Surveillance for hepatocellular carcinoma (HCC) with ultrasound in high-risk populations is generally believed to improve opportunities for treatment. However, tumors are still missed due to various factors. This study explores success versus failure of HCC surveillance.METHODS:
This is a retrospective study of 1,125 HCC cases. Categories considered for successful detection were largest tumor ≤3.0 cm, single tumors ≤3.0 cm and ≤2.0 cm, and adherence to Milan criteria. Examined factors were age <60 years, gender, rural residence, body-mass index (BMI), hepatitis infection, smoking, diabetes, hyperlipidemia, cirrhosis, ascites, and Model for End-Stage Liver Disease <10.RESULTS:
HCC was found on surveillance in 257 patients with a mean tumor size of 3.17 cm; multiple tumors were seen in 28% of cases, bilateral tumors in 7.4%, and vascular invasion in 3.7%. Surveillance was successful in 61.5% of cases involving a largest tumor ≤3.0 cm, with BMI ≥35 negatively affecting detection (odds ratio [OR] 0.28, P=0.014) and cirrhosis positively affecting detection (OR 2.31, P=0.036). Ultrasound detected 19.1% of single tumors ≤2.0 cm with ascites improving the detection rate (OR 3.89, P=0.001). Finally, adherence to Milan criteria occurred in 75.1% of cases, revealing negative associations with diabetes (OR 0.48, P=0.044 and male gender (OR 0.49, P=0.08).CONCLUSIONS:
Although surveillance is recommended for HCC, not all surveillance ultrasound are ideal. Tumor detection can depend on gender, BMI, diabetes, cirrhosis, and ascites and is achieved in 19.1–75% of cases depending on the definition of success. Closer follow-up or additional imaging might be necessary for some patient subgroups.Key words
Full text:
1
Database:
WPRIM
Main subject:
Ascites
/
Smoke
/
Fibrosis
/
Smoking
/
Population Surveillance
/
Retrospective Studies
/
Follow-Up Studies
/
Ultrasonography
/
Carcinoma, Hepatocellular
/
Early Detection of Cancer
Type of study:
Diagnostic_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Limits:
Humans
/
Male
Language:
En
Journal:
Clinical and Molecular Hepatology
Year:
2017
Document type:
Article