Gastroenterology

Gastroenterology

Volume 126, Issue 4, April 2004, Pages 1005-1014
Gastroenterology

Clinical-liver, pancreas, and biliary tract
Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance

https://doi.org/10.1053/j.gastro.2003.12.049Get rights and content

Abstract

Background & Aims: Significant improvements in management of hepatocellular carcinoma (HCC) have occurred in the last years, but their impact on surveillance outcome is unknown. To clarify this, we compared survival of HCC patients identified along 3 consecutive quinquennia of surveillance. Methods: A cohort of 417 HCC-free outpatients with compensated cirrhosis was prospectively followed for 148 months (range, 1–213 months) with periodic ultrasound examinations. Results: HCC developed in 112 patients, at a 3.4% rate per year, and was the prime cause of death (n = 54). Forty-six (41%) patients had a single tumor, with a mean size of 3.7 cm, 3.0 cm, and 2.2 cm in the 3 quinquennia (first vs. second: ns; first vs. third: P = 0.017; second vs. third: P = 0.02), and 38 (44%) underwent radical therapy. Mortality rates in HCC patients fell from 45% in the first quinquennium to 37% in the second and 10% in the third (first vs. second: ns; first vs. third: P = 0.0009; second vs. third: P = 0.018) in parallel with a reduction in yearly mortality of treated patients (34%, 28%, and 5%, respectively; first vs. second: ns; second vs. third: P = 0.036; first vs. third: P = 0.0024). After stratification for quinquennium, tumor staging, according to Cancer of the Liver Italian Program (CLIP), was the only independent predictor of survival (P = 0.015). Conclusions: Cirrhotic patients developing a HCC during the last 5 years of surveillance survived longer than previously, as a consequence of improved management of the tumor and complications of cirrhosis.

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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  • Cited by (0)

    Supported by the Consorzio Interuniversitario Trapianti d’Organo, the Italian Foundation for Cancer Research (FIRC), and the Ricerca Finalizzata 2000 Ospedale Maggiore IRCCS.

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