Clin Mol Hepatol.
2017 Sep;23(3):239-248. 10.3350/cmh.2017.0008.
Pitfalls in surveillance for hepatocellular carcinoma: How successful is it in the real world?
- Affiliations
-
- 1Department of Surgery, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA. hepatoma@aol.com
- 2Cancer Center, University of Hawaii, Honolulu, HI, USA.
- 3University of Hawaii, John A. Burns School of Medicine, Honolulu, HI, USA.
- 4Positron Emission Tomography Imaging Research, The Queen's Medical Center, Honolulu, HI, USA.
- 5Liver Center, The Queen’s Medical Center, Honolulu, HI, USA.
- KMID: 2400671
- DOI: http://doi.org/10.3350/cmh.2017.0008
Abstract
- BACKGROUND/AIMS
Surveillance for hepatocellular carcinoma (HCC) with ultrasound in high-risk populations is generally believed to improve opportunities for treatment. However, tumors are still missed due to various factors. This study explores success versus failure of HCC surveillance.
METHODS
This is a retrospective study of 1,125 HCC cases. Categories considered for successful detection were largest tumor ≤3.0 cm, single tumors ≤3.0 cm and ≤2.0 cm, and adherence to Milan criteria. Examined factors were age <60 years, gender, rural residence, body-mass index (BMI), hepatitis infection, smoking, diabetes, hyperlipidemia, cirrhosis, ascites, and Model for End-Stage Liver Disease <10.
RESULTS
HCC was found on surveillance in 257 patients with a mean tumor size of 3.17 cm; multiple tumors were seen in 28% of cases, bilateral tumors in 7.4%, and vascular invasion in 3.7%. Surveillance was successful in 61.5% of cases involving a largest tumor ≤3.0 cm, with BMI ≥35 negatively affecting detection (odds ratio [OR] 0.28, P=0.014) and cirrhosis positively affecting detection (OR 2.31, P=0.036). Ultrasound detected 19.1% of single tumors ≤2.0 cm with ascites improving the detection rate (OR 3.89, P=0.001). Finally, adherence to Milan criteria occurred in 75.1% of cases, revealing negative associations with diabetes (OR 0.48, P=0.044 and male gender (OR 0.49, P=0.08).
CONCLUSIONS
Although surveillance is recommended for HCC, not all surveillance ultrasound are ideal. Tumor detection can depend on gender, BMI, diabetes, cirrhosis, and ascites and is achieved in 19.1-75% of cases depending on the definition of success. Closer follow-up or additional imaging might be necessary for some patient subgroups.
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