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Published on: February 19, 2019
Hepatocellular carcinoma surveillance at 4- vs. 12-month intervals for patients with chronic viral hepatitis: a
Jing-Houng Wang1, Kuo-Chin Chang, Kwong-Ming Kee
1Department of Internal Medicine, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, NiaoSong, Kaohsiung, Taiwan.
Insights
Shorter surveillance intervals for hepatocellular carcinoma (HCC) in high-risk patients detect smaller tumors. However, 4-month versus 12-month screening did not impact overall survival rates in this study.
Area of Science:
- Hepatology and Gastroenterology
- Oncology
- Public Health
Background:
- Patients with chronic viral hepatitis and thrombocytopenia are at increased risk for hepatocellular carcinoma (HCC).
- Current surveillance guidelines for HCC often recommend 6-month intervals, but optimal frequency remains debated, especially in specific patient populations.
Purpose of the Study:
- To compare the effectiveness of 4-month versus 12-month ultrasonography (US) surveillance intervals for detecting hepatocellular carcinoma (HCC).
- To assess the stage at diagnosis and treatment outcomes for HCC detected by different surveillance frequencies in at-risk individuals.
Main Methods:
- A randomized community-based study involving adults (≥ 40 years) with chronic viral hepatitis and thrombocytopenia (platelet count ≤ 150 × 10(9)/l).
- Participants were assigned to either 4-month (Group A) or 12-month (Group B) US surveillance intervals.
- Data on HCC incidence, tumor characteristics, stage, treatment, and survival were collected and analyzed.
Main Results:
- While cumulative 3-year HCC incidence did not differ between groups, the 4-month interval (Group A) detected smaller tumors (≤ 2 cm) compared to the 12-month interval (Group B).
- Patients in Group A were more likely to be diagnosed at a very-early stage (Barcelona Clinic Liver Cancer staging) and receive curative treatments.
- Male gender, cirrhosis, and lower platelet counts (≤ 100 × 10(9)/l) were identified as risk factors for HCC development.
Conclusions:
- Four-month ultrasonography surveillance for hepatocellular carcinoma (HCC) in patients with chronic viral hepatitis and thrombocytopenia identifies tumors at an earlier stage, suitable for curative treatment.
- Despite earlier detection, the 4-month surveillance interval did not demonstrate a significant difference in overall survival up to 4 years compared to the 12-month interval.
Objectives:
To compare the efficacy of hepatocellular carcinoma (HCC) surveillance at 4- and 12-month intervals in a community for patients with chronic viral hepatitis and thrombocytopenia.
Methods:
In 10 townships, adults (≥ 40 years) with platelet ≤ 150 (× 10(9))/l, positive hepatitis B surface antigen, or antibody to hepatitis C virus were invited to this study. These townships were randomized into 4- (group A) and 12-month (group B) interval surveillance groups. Seven hundred and eighty-five and 796 residents met the study criteria in groups A and B. Ultrasonography (US) was the surveillance method.
Results:
A total of 744 residents (group A: 387; group B: 357) were enrolled. In the study period, HCC was diagnosed in 39 residents (group A: 24; group B: 15). There was no difference in cumulative 3-year HCC incidence between the two groups. The tumors were smaller in group A than in group B, though group A had more patients with tumor ≤ 2 cm (P = 0.003) who were in Barcelona Clinic Liver Cancer (BCLC) very-early stage (P = 0.017) and had undergone curative treatments (P = 0.049). Male gender, cirrhosis, and platelet ≤ 100 (× 10(9))/l were associated factors of HCC occurrence. There was no difference in 4-year overall survival between the two groups. Patients undergoing recommended treatments had better 4-year survival rates.
Conclusions:
Compared with 12-month interval, US surveillance at 4-month interval detected more patients with HCC ≤ 2 cm who were in BCLC very-early stage and were fit for curative treatments. Up to 4-year follow-up, however, the overall survival was not different.
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