Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance.

By A. Sangiovanni, E. Del Ninno, P. Fasani, C. de Fazio, G. Ronchi, R. Romeo, A. Morabito, R. de Franchis, M. Colombo. Gastroenterology, 2004

610 citations recorded by the source corpus.

BACKGROUND & AIMS Significant improvements in management of hepatocellular carcinoma (HCC) have occurred in the last years, but their impact on surveillance outcome is unknown. To clarify this, we compared survival of HCC patients identified along 3 consecutive quinquennia of surveillance. METHODS A cohort of 417 HCC-free outpatients with compensated cirrhosis was prospectively followed for 148 months (range, 1-213 months) with periodic ultrasound examinations. RESULTS HCC developed in 112 patients, at a 3.4% rate per year, and was the prime cause of death (n = 54). Forty-six (41%) patients had a single tumor, with a mean size of 3.7 cm, 3.0 cm, and 2.2 cm in the 3 quinquennia (first vs. second: ns; first vs. third: P = 0.017; second vs. third: P = 0.02), and 38 (44%) underwent radical therapy. Mortality rates in HCC patients fell from 45% in the first quinquennium to 37% in the second and 10% in the third (first vs. second: ns; first vs. third: P = 0.0009; second vs. third: P = 0.018) in parallel with a reduction in yearly mortality of treated patients (34%, 28%, and 5%, respectively; first vs. second: ns; second vs. third: P = 0.036; first vs. third: P = 0.0024). After stratification for quinquennium, tumor staging, according to Cancer of the Liver Italian Program (CLIP), was the only independent predictor of survival (P = 0.015). CONCLUSIONS Cirrhotic patients developing a HCC during the last 5 years of surveillance survived longer than previously, as a consequence of improved management of the tumor and complications of cirrhosis.

Subfields: Epidemiology, Hepatology

View Paper: https://www.semanticscholar.org/paper/b3d75ef68fe39acc3fb702d97732f58706d6eb8b

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Citations in the corpus

Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis: Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma (2007, neutral): “Nodular lesions were categorized as follows: (1) conclusive HCC diagnosis: nodules displaying intense contrast enhancement in the arterial phase and washout in 1 of the venous phases (portal or delayed), (2) suggestive of HCC, but nonconclusive: nodules showing enhancement during the hepatic arteria”
Management of hepatocellular carcinoma (2005, neutral): “More than 500,000 new cases are diagnosed per year and it is the third cause of cancer-related death and the first cause of death in patients with cirrhosis [1].”
EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. (2012, result): “On the other hand, cohort comparisons of 6 versus 12-month schemes provide similar results [52,92], while retrospective studies identified better performance of the 6-month interval in terms of stage migration (small HCC amenable for curative treatments) [96] and survival [97].”
MiR-221 controls CDKN1C/p57 and CDKN1B/p27 expression in human hepatocellular carcinoma (2008, background): “The early diagnosis and improvements in HCC treatment has positively impacted survival of HCC patients over the past decade (Sangiovanni et al., 2004).”
EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. (2012, result): “On the other hand, cohort comparisons of 6 versus 12-month schemes provide similar results [52,92], while retrospective studies identified better performance of the 6-month interval in terms of stage migration (small HCC amenable for curative treatments) [96] and survival [97].”
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Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis (2018, background): “8%) were detected at an early stage.(15,20,22,23,27-32,36,39,40,43,46)”