Pitfalls in surveillance for hepatocellular carcinoma: How successful is it in the real world?.
- Author:
Linda L. WONG
1
;
Ruel J REYES
;
Sandi A KWEE
;
Brenda Y HERNANDEZ
;
Sumodh C KALATHIL
;
Naoky C TSAI
Author Information
- Publication Type:Original Article
- Keywords: Carcinoma; Hepatocellular; Early detection of cancer; Population surveillance; Ultrasonography
- MeSH: Ascites; Carcinoma, Hepatocellular*; Early Detection of Cancer; Fibrosis; Follow-Up Studies; Hepatitis; Humans; Hyperlipidemias; Liver Diseases; Male; Population Surveillance; Retrospective Studies; Smoke; Smoking; Ultrasonography
- From:Clinical and Molecular Hepatology 2017;23(3):239-248
- CountryRepublic of Korea
- Language:English
- 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.
