Shorter surveillance intervals detect HCC earlier

Hepatocellular carcinoma (HCC) surveillance in at-risk patients at intervals of less than 6 months picks up smaller tumors compared with longer intervals, show two recently published studies.

Kwang-Hyub Han (Yonsei University College of Medicine, Seoul, South Korea) and colleagues followed up 10,307 patients considered at high-risk for HCC due to hepatitis B virus (HBV) and/or cirrhosis between 1990 and 2004.

Patients were recommended to undergo HCC surveillance with alpha-fetoprotein and ultrasound at intervals of less than 6 months. However, for various reasons, some patients underwent screening at longer intervals.

During follow up, 219 patients were diagnosed with HCC with a median surveillance interval of 5.5 months (short-interval group), and 181 patients were diagnosed with a median surveillance interval of 11.0 months (long-interval group), the authors report in the Journal of Clinical Gastroenterology.

Han and colleagues found that patients in the former group had a significantly smaller mean tumor size at diagnosis, at 3 cm compared with 4 cm in patients screened less frequently. Indeed, 62.1% of short-interval group patients had a solitary HCC of 3 cm or less compared with 51.5% in the long interval group.

These authors also found that 5-year survival was significantly better in the short interval group, at 31.4% compared with 23.3% in the long interval group.

In a smaller study, Sheng-Nan Lu (Chang Gung University, Kaohsiung, Taiwan) and colleagues assessed a community-based ultrasound surveillance program among patients with HBV or hepatitis C virus infection, involving 385 patients examined every 4 months (short-interval group), and 357 every 12 months (long-interval group).

During the 3-year follow up, 24 HCC cases were picked up in the short-interval group, and 15 in the long-interval group. Similar to the findings of Han and colleagues, patients in the short-interval group had significantly smaller tumors, at a mean of 1.9 cm compared with 2.9 cm in the long-interval group.

However, Lu et al found no significant difference in cumulative survival over 4 years between groups, at 57.4% in the short-interval group, and 56.0% in the long-interval group.

European, American, and Asian Pacific guidelines recommend 6-month surveillance intervals for HCC, and even shorter intervals are common practice. However, until now, there have been no prospective, randomized trials to confirm the benefits of adhering to this guidance.

"On the basis of this evidence, the optimal [ultrasound] surveillance interval might be 4 or 6 months to detect HCC of 2 cm or less for patients with chronic viral hepatitis an thrombocytopenia or those with cirrhosis," conclude Lu and colleagues in the American Journal of Gastroenterology.

"Increasing the detection rate of patients with very-early stage HCC might translate into greater applicability of effective treatments and into better survival rates."

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