Utility of screening for hepatocellular carcinoma among cirrhotics

Screening known cirrhotics for hepatocellular cancer (HCC) has long been a contentious topic. Studies to date have failed to conclusively prove or disprove the validity of α-fetoprotein (AFP) and hepatic ultrasound as screening mechanisms for HCC among cirrhotics, particularly in the American population. It is not clear whether these screening mechanisms provide any benefit in terms of reduced morbidity and mortality.

The study examined all patients with liver cirrhosis who developed HCC at the Michael E DeBakey VA Medical Center between 1999 and 2005. Those who were screened with AFP and/or imaging (either ultrasound, triphasic liver protocol CT or MRI) were compared with those patients who were not screened at all. The screened and unscreened patients were compared in terms of Barcelona Clinic Liver Cancer (BCLC) stage at the time of diagnosis.

Statistical analysis revealed a significant difference between the screened and unscreened groups in terms of BCLC stage at diagnosis, with the unscreened group being diagnosed at later stages than the screened group. Of the 155 patients observed, 26 were appropriately screened, and 129 were not. The BCLC stages at diagnosis for the two groups were as follows: screened patients: 34.6%, 38.5%, 7.7% and 19.2% for BCLC stages A, B, C and D, respectively; unscreened patients: 12.4%, 24.8%, 27.1% and 35.7% for BCLC stages A, B, C and D, respectively. The different trend in the two groups was found to be statistically significant, with a p value of 0.004. Furthermore, among the screened group, no particular method of screening (AFP vs imaging vs combination) was shown to be superior to another.

Screening for HCC among cirrhotics using AFP and/or imaging every 6 months does correlate with HCC diagnosis at an earlier BCLC stage, thus portending better treatment options and improved prognosis. Therefore, screening all known cirrhotics for HCC may lead to decreased mortality.