Early detection of hepatocellular carcinoma in patients with chronic type B hepatitis. A prospective study

Area of Science:

• Hepatology
• Oncology
• Gastroenterology

Background:

• Chronic hepatitis B virus infection is a major risk factor for hepatocellular carcinoma (HCC).
• Early detection of HCC is crucial for improving patient outcomes and treatment efficacy.
• Current surveillance methods require optimization for effective early diagnosis.

Purpose of the Study:

• To evaluate the efficacy of combined alpha-fetoprotein (AFP) testing and high-resolution ultrasonography for prospective surveillance of HCC.
• To determine the incidence and risk factors for HCC development in patients with chronic hepatitis B.
• To assess the stage and resectability of HCC detected through this surveillance strategy.

Main Methods:

• A prospective surveillance study involving 432 patients with proven chronic type B hepatitis.
• Utilized serum alpha-fetoprotein levels and high-resolution, linear-array, real-time ultrasonography for screening.
• Follow-up period ranged from 6 to 85 months (median 23 months).

Main Results:

• Asymptomatic HCC was detected in 8 patients, yielding an annual incidence of 826/100,000 (2768/100,000 for those over 35).
• Hepatitis B surface antigen-positive patients had a 2-fold increased risk of HCC compared to negative patients (5-fold for those over 35).
• Detected HCCs were generally early-stage, small, and often resectable, with lower rates of cirrhosis and hepatitis B e antibody positivity.

Conclusions:

• Combined AFP and ultrasonography surveillance is recommended for patients with chronic hepatitis B to enhance early HCC detection.
• This strategy improves the likelihood of successful surgical resection for early-stage HCC.
• HCC development and progression to cirrhosis may be independent sequelae of chronic hepatitis B virus infection.