Reuters Health Information (2013-05-09): Arterial studies add little to CT for finding liver cancer
Arterial studies add little to CT for finding liver cancer
Last Updated: 2013-05-09 14:27:26 -0400 (Reuters Health)
NEW YORK (Reuters Health) - The combination of computed tomography with hepatic arteriography and arterial portography (CTHA/CTAP) spots hepatocellular carcinoma (HCC) nodules undetected by conventional dynamic CT -- but to no practical avail, according to Japanese researchers.
As Dr. Ryosuke Tateishi of the University of Tokyo told Reuters Health by email, "CTHA/CTAP may detect recurrent lesions earlier. However, ironically the benefit was negated because those in whom CTHA/CTAP showed additional nodules were also high-risk patients for recurrence."
Although the approach is among the most sensitive for detecting HCC nodules, its disadvantages include "invasiveness, high cost, and a high false-positive rate," Dr. Tateishi and colleagues wrote in an April 30th online paper in The American Journal of Gastroenterology.
To determine whether the benefits were worth the risks and the cost, the team studied 280 patients with HCC diagnosed by conventional dynamic CT. Prior to radiofrequency ablation they were randomized to undergo CTHA/CTAP, or not.
CTHA/CTAP found 75 previously undetected HCC nodules in 45 patients - but the additional information did not yield a benefit. At one year, the cumulative recurrence-free survival rates were similar at 60.1% in CTHA/CTAP patients and 52.2% in controls. At two years, the proportions were 29.0% vs 29.7% and at three years, 18.9% vs 23.1%.
The figures for cumulative overall survival were also similar. At three years, these were 79.7% vs 86.8% for the intervention and control groups, respectively, and at five years, 56.4% and 60.1%.
By the end of the follow-up, tumor had recurred in 109 CTHA/CTAP patients (78.4 %) and 112 control patients (81.2 %).
Overall, say the investigators, like other new imaging modalities, CTHA/CTAP improved detection but not survival. "Better diagnosis," they conclude, "does not necessarily lead to better primary outcome."
Am J Gastroenterol 2013.