Factors that affect efficacy of ultrasound surveillance for early stage hepatocellular carcinoma in patients with cirrhosis
Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved..
BACKGROUND & AIMS: Ultrasound surveillance does not detect early stage hepatocellular carcinomas (HCCs) in some patients with cirrhosis, although the reasons for this have not been well studied. We assessed the rate at which ultrasound fails to detect early stage HCCs and factors that affect its performance.
METHODS: We collected information on 1170 consecutive patients included in the Italian Liver Cancer (ITA.LI.CA) database who had Child-Pugh A or B cirrhosis and were diagnosed with HCC during semiannual or annual ultrasound surveillance, from January 1987 through December 2008. Etiologies included hepatitis C virus infection (59.3%), alcohol abuse (11.3%), hepatitis B virus infection (9%), a combination of factors (15.6%), and other factors (4.7%). Surveillance was considered to be a failure when patients were diagnosed with HCC at a stage beyond the Milan criteria (1 nodule ≤5 cm or ≤3 nodules each ≤3 cm).
RESULTS: HCC was found beyond Milan criteria in 34.3% of surveilled patients (32.2% during semi-annual surveillance and 41.3% during annual surveillance; P < .01). Nearly half of surveillance failures were associated with at least one indicator of aggressive HCC (levels of AFP >1000 ng/mL, infiltrating tumors, or vascular invasion and metastases). Semiannual surveillance, female sex, Child-Pugh class A, and α-fetoprotein levels of 200 ng/mL or less were associated independently with successful ultrasound screening for HCC.
CONCLUSIONS: Based on our analysis of surveillance for HCC in patients with cirrhosis, the efficacy of ultrasound-based screening is acceptable. Ultrasound was least effective in identifying aggressive HCC, and at surveillance intervals of more than 6 months.
Medienart: |
E-Artikel |
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Erscheinungsjahr: |
2014 |
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Erschienen: |
2014 |
Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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Enthalten in: |
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association - 12(2014), 11 vom: 05. Nov., Seite 1927-33.e2 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Del Poggio, Paolo [VerfasserIn] |
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Anmerkungen: |
Date Completed 14.07.2015 Date Revised 18.03.2022 published: Print-Electronic Citation Status MEDLINE |
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doi: |
10.1016/j.cgh.2014.02.025 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
NLM235976946 |
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520 | |a Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved. | ||
520 | |a BACKGROUND & AIMS: Ultrasound surveillance does not detect early stage hepatocellular carcinomas (HCCs) in some patients with cirrhosis, although the reasons for this have not been well studied. We assessed the rate at which ultrasound fails to detect early stage HCCs and factors that affect its performance | ||
520 | |a METHODS: We collected information on 1170 consecutive patients included in the Italian Liver Cancer (ITA.LI.CA) database who had Child-Pugh A or B cirrhosis and were diagnosed with HCC during semiannual or annual ultrasound surveillance, from January 1987 through December 2008. Etiologies included hepatitis C virus infection (59.3%), alcohol abuse (11.3%), hepatitis B virus infection (9%), a combination of factors (15.6%), and other factors (4.7%). Surveillance was considered to be a failure when patients were diagnosed with HCC at a stage beyond the Milan criteria (1 nodule ≤5 cm or ≤3 nodules each ≤3 cm) | ||
520 | |a RESULTS: HCC was found beyond Milan criteria in 34.3% of surveilled patients (32.2% during semi-annual surveillance and 41.3% during annual surveillance; P < .01). Nearly half of surveillance failures were associated with at least one indicator of aggressive HCC (levels of AFP >1000 ng/mL, infiltrating tumors, or vascular invasion and metastases). Semiannual surveillance, female sex, Child-Pugh class A, and α-fetoprotein levels of 200 ng/mL or less were associated independently with successful ultrasound screening for HCC | ||
520 | |a CONCLUSIONS: Based on our analysis of surveillance for HCC in patients with cirrhosis, the efficacy of ultrasound-based screening is acceptable. Ultrasound was least effective in identifying aggressive HCC, and at surveillance intervals of more than 6 months | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Early Detection | |
650 | 4 | |a Fibrosis | |
650 | 4 | |a Liver Cancer | |
650 | 4 | |a Survival | |
700 | 1 | |a Olmi, Stefano |e verfasserin |4 aut | |
700 | 1 | |a Ciccarese, Francesca |e verfasserin |4 aut | |
700 | 1 | |a Di Marco, Mariella |e verfasserin |4 aut | |
700 | 1 | |a Rapaccini, Gian Ludovico |e verfasserin |4 aut | |
700 | 1 | |a Benvegnù, Luisa |e verfasserin |4 aut | |
700 | 1 | |a Borzio, Franco |e verfasserin |4 aut | |
700 | 1 | |a Farinati, Fabio |e verfasserin |4 aut | |
700 | 1 | |a Zoli, Marco |e verfasserin |4 aut | |
700 | 1 | |a Giannini, Edoardo Giovanni |e verfasserin |4 aut | |
700 | 1 | |a Caturelli, Eugenio |e verfasserin |4 aut | |
700 | 1 | |a Chiaramonte, Maria |e verfasserin |4 aut | |
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700 | 1 | |a Cucchetti, Alessandro |e investigator |4 oth | |
700 | 1 | |a Domenicali, Marco |e investigator |4 oth | |
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700 | 1 | |a Gramenzi, Annagiulia |e investigator |4 oth | |
700 | 1 | |a Garuti, Francesca |e investigator |4 oth | |
700 | 1 | |a Lenzi, Barbara |e investigator |4 oth | |
700 | 1 | |a Magalotti, Donatella |e investigator |4 oth | |
700 | 1 | |a Ravaioli, Matteo |e investigator |4 oth | |
700 | 1 | |a Alberti, Alfredo |e investigator |4 oth | |
700 | 1 | |a Gatta, Angelo |e investigator |4 oth | |
700 | 1 | |a Gios, Maurizio |e investigator |4 oth | |
700 | 1 | |a Giacomin, Anna |e investigator |4 oth | |
700 | 1 | |a Vanin, Veronica |e investigator |4 oth | |
700 | 1 | |a Pozzan, Caterina |e investigator |4 oth | |
700 | 1 | |a Maddalo, Gemma |e investigator |4 oth | |
700 | 1 | |a Cappelli, Alberta |e investigator |4 oth | |
700 | 1 | |a Giampalma, Emanuela |e investigator |4 oth | |
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