Epidemiology

More frequent surveillance for hepatocellular carcinoma detects more small tumors

Last Updated: 2013-01-30 12:10:29 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Hepatocellular carcinoma (HCC) surveillance every four months detects more small tumors than surveillance every 12 months, but this doesn't translate into improved survival, researchers from Taiwan report.

The appropriate surveillance interval for high-risk patients isn't clear, but most guidelines call for seeing patients more often than once a year. The European Association for the Study of the Liver, the American Association for the Study of Liver Disease, and the Asian Pacific Association of the Study of Liver all recommend a six-month surveillance interval, while the Japan Society of Hepatology has proposed a three- to four-month interval "for super high-risk patients," Dr. Sheng-Nan Lu from Chang Gung University College of Medicine, Kaohsiung, Taiwan and colleagues said in a paper online January 15th in The American Journal of Gastroenterology.

For their report, the researchers studied 744 adults with chronic viral hepatitis and thrombocytopenia from 10 townships in Taiwan that were cluster-randomized to four- or 12-month HCC surveillance intervals. Each surveillance visit included liver ultrasound.

The researchers found new hepatic nodules significantly more often when surveillance was done every four months (46/387) vs every 12 months (28/357; p=0.049) - but the three-year cumulative HCC incidence did not differ significantly between the four- and 12-month protocols (11.7% vs 9.7%; p=0.198).

Mean diameters of the detected tumors were significantly smaller in the four-month group than in the 12-month group (1.9 vs 2.8 cm; p=0.006), and the four-month group had more patients with HCC no larger than 2 cm (p=0.003).

In addition, more patients in the four-month group had curative treatment (13 vs 3, p=0.049). But while patients who underwent recommended treatments had significantly better survival than patients who did not, there was no significant difference in cumulative survival at one, two or four years between the four-month and 12-month surveillance groups.

How often, then, should individuals like these undergo surveillance ultrasonography? Dr. Lu concluded, "It should be four to six months for such patients with cirrhosis or thrombocytopenia. In some areas without sufficient medical resources, one year should be acceptable."

But, Dr. Lu acknowledged, "Because most of our detected patients were in an early stage, they have long survival. And it should be hard to prove the prognosis difference between tumors with diameters of 2.8 cm and 1.9 cm, especially since both underwent curative treatment."

Dr. Franco Trevisani from University of Bologna, Bologna, Italy has conducted a similar study. He told Reuters Health, "I think these results are affected by a number of limitations (adherence to the scheduled surveillance programs, number and management of HCCs detected in the two groups, etc.) that do not allow the authors to provide robust evidence that the four-month and 12-month surveillance programs for HCC are equivalent in terms of patients survival, particularly in cirrhotic patients, who are those at highest risk of HCC development."

"Hence," Dr. Trevisani concluded, "the paper cannot be considered a document that can convince clinicians to derogate from the recommendations released by the current western and eastern practice guidelines, provided that cost-effectiveness analyses favoring annual surveillance in some patient subsets - at very low HCC risk - are taken into account."

SOURCE: http://bit.ly/VnQzGe

Am J Gastroenterol 2013.