Clinical-liver, pancreas, and biliary tractIncreased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance☆
Section snippets
Patients
Between October 1985 and October 1986, 447 patients aged 36–72 years, with compensated cirrhosis were recruited and prospectively followed-up with annual US examination of the liver and serum α-fetoprotein (AFP) assays. We excluded patients with Child-Pugh grade C14 disease on the assumption that they were unlikely to survive long enough to allow a meaningful evaluation. None of the patients had ascites or jaundice at enrollment. However, 17 patients in Child-Pugh B stage had had ascites in the
Results
The study time was 148 months (range, 1–213 months). Three hundred patients (72%) were followed until development of HCC, death, or longer than 10 years. Overall, 165 patients were lost to follow-up and censored at the last visit, corresponding to a 4.1% per year loss that remained linear along the entire follow-up period. One hundred forty-nine patients (4.0% per year) died, and 103 (25%) are still alive at the end of follow-up. One hundred fifty patients had higher than 20 ng/mL levels of AFP
Discussion
This study clearly demonstrates an increase in survival of patients with compensated cirrhosis in whom a HCC was detected during the last quinquennium of surveillance. The recognition that the outcome of patients developing HCC while under surveillance has significantly improved in the last years has important clinical implications because we demonstrated also that HCC was the prime cause of death in patients with compensated cirrhosis.
The increase in survival of HCC patients identified during
Acknowledgements
The authors thank Caterina M. Puricelli for expert secretarial assistance and Dr. Piero Biondetti and Dr. Laura Forzenigo, Department of Radiology, for help in the investigations.
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Supported by the Consorzio Interuniversitario Trapianti d’Organo, the Italian Foundation for Cancer Research (FIRC), and the Ricerca Finalizzata 2000 Ospedale Maggiore IRCCS.