Clinical Gastroenterology and Hepatology
Article in Press
Factors That Affect Efficacy Of Ultrasound Surveillance For Early-Stage Hepatocellular Carcinoma In Patients With Cirrhosis
Paolo Del Poggio, Stefano Olmi, Francesca Ciccarese, Mariella Di Marco, Gian Ludovico Rapaccini, Luisa Benvegnù, Franco Borzio, Fabio Farinati, Marco Zoli, Edoardo Giovanni Giannini, Eugenio Caturelli, Maria Chiaramonte, Franco Trevisani, Italian Liver Cancer (ITA.LI.CA) group
Received 15 October 2013; received in revised form 11 February 2014; accepted 12 February 2014. published online 28 February 2014.
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.
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 semi-annual 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).
Ultrasound surveillance failed to detect HCC in 34.3 % of patients and more often in the annual program than in the semiannual one. (41.3% vs 32.2 % ; P<0.01). 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). Semi-annual surveillance, female sex, Child-Pugh class A, and AFP levels ≤ 200 ng/ml were independently associated with successful ultrasound screening for HCC.
Based on analysis of surveillance for HCC in patients with cirrhosis , the efficacy of ultrasound-based screening is acceptable. Ultrasound is least effective in identifying aggressive HCC, and at surveillance intervals >6 months.