Screening for hepatocellular carcinoma in patients with advanced cirrhosis

Naga Chalasani, John C. Horlander, Areen Said, Helena Hoen, Kenyon K. Kopecky, Stephan M. Stockberger, Rajesh Manam, Paul Y. Kwo, Lawrence Lumeng

Research output: Contribution to journalArticle

110 Citations (Scopus)

Abstract

OBJECTIVE: Most available data on screening for hepatocellular carcinoma (HCC) in patients with cirrhosis originate from Asia and Europe. These data may not be applicable to patients from the United States because of geographic variation in the underlying etiology and other factors. Our aim was to assess the risk of HCC in U.S. patients with cirrhosis undergoing standardized screening. METHODS: All cirrhotic patients evaluated for liver transplantation at our institution from January 1, 1994-December 31, 1997 were included in this study. The screening strategy included initial screening, which was offered to all patients and consisted of alpha- fetoprotein (AFP), abdominal ultrasound, and computed tomography (CT) scan, and extended screening, which was performed only on transplant-eligible patients and consisted of semiannual AFP and ultrasound. RESULTS: During the study period, 285 patients with cirrhosis were evaluated for transplantation and underwent initial screening. Of these, 166 were eligible for transplantation and underwent extended screening during a median follow-up of 15 months (range 6-42 months). Twenty-seven HCC were found, 22 during initial screening and five during extended screening. The cancer-free proportions of the cohort who underwent extended screening at 1, 2, and 3.5 yr were 98.6% ± 1.4%, 96.4 ± 1.8%, and 77.1% ± 1.7%, respectively (mean ± SE). Hepatitis C, either alone or in part, was the etiology in 63% of patients with HCC. The sensitivity of CT scan (88%) was significantly higher than AFP > 20 ng/ml (62%) and ultrasound (59%) for detecting HCC (p < 0.001). CONCLUSIONS: In patients with established cirrhosis, the risk of detecting HCC is maximal at the baseline screening (7%). Hepatitis C was the most common etiology for cirrhosis in study. In U.S. patients with established cirrhosis, CT scan exhibited higher sensitivity for detecting HCC than ultrasound or AFP.

Original languageEnglish
Pages (from-to)2988-2993
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume94
Issue number10
DOIs
StatePublished - Oct 1999

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Hepatocellular Carcinoma
Fibrosis
alpha-Fetoproteins
Tomography
Hepatitis C
Transplantation
Liver Transplantation
Transplants

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Chalasani, N., Horlander, J. C., Said, A., Hoen, H., Kopecky, K. K., Stockberger, S. M., ... Lumeng, L. (1999). Screening for hepatocellular carcinoma in patients with advanced cirrhosis. American Journal of Gastroenterology, 94(10), 2988-2993. https://doi.org/10.1111/j.1572-0241.1999.01448.x

Screening for hepatocellular carcinoma in patients with advanced cirrhosis. / Chalasani, Naga; Horlander, John C.; Said, Areen; Hoen, Helena; Kopecky, Kenyon K.; Stockberger, Stephan M.; Manam, Rajesh; Kwo, Paul Y.; Lumeng, Lawrence.

In: American Journal of Gastroenterology, Vol. 94, No. 10, 10.1999, p. 2988-2993.

Research output: Contribution to journalArticle

Chalasani, N, Horlander, JC, Said, A, Hoen, H, Kopecky, KK, Stockberger, SM, Manam, R, Kwo, PY & Lumeng, L 1999, 'Screening for hepatocellular carcinoma in patients with advanced cirrhosis', American Journal of Gastroenterology, vol. 94, no. 10, pp. 2988-2993. https://doi.org/10.1111/j.1572-0241.1999.01448.x
Chalasani, Naga ; Horlander, John C. ; Said, Areen ; Hoen, Helena ; Kopecky, Kenyon K. ; Stockberger, Stephan M. ; Manam, Rajesh ; Kwo, Paul Y. ; Lumeng, Lawrence. / Screening for hepatocellular carcinoma in patients with advanced cirrhosis. In: American Journal of Gastroenterology. 1999 ; Vol. 94, No. 10. pp. 2988-2993.
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abstract = "OBJECTIVE: Most available data on screening for hepatocellular carcinoma (HCC) in patients with cirrhosis originate from Asia and Europe. These data may not be applicable to patients from the United States because of geographic variation in the underlying etiology and other factors. Our aim was to assess the risk of HCC in U.S. patients with cirrhosis undergoing standardized screening. METHODS: All cirrhotic patients evaluated for liver transplantation at our institution from January 1, 1994-December 31, 1997 were included in this study. The screening strategy included initial screening, which was offered to all patients and consisted of alpha- fetoprotein (AFP), abdominal ultrasound, and computed tomography (CT) scan, and extended screening, which was performed only on transplant-eligible patients and consisted of semiannual AFP and ultrasound. RESULTS: During the study period, 285 patients with cirrhosis were evaluated for transplantation and underwent initial screening. Of these, 166 were eligible for transplantation and underwent extended screening during a median follow-up of 15 months (range 6-42 months). Twenty-seven HCC were found, 22 during initial screening and five during extended screening. The cancer-free proportions of the cohort who underwent extended screening at 1, 2, and 3.5 yr were 98.6{\%} ± 1.4{\%}, 96.4 ± 1.8{\%}, and 77.1{\%} ± 1.7{\%}, respectively (mean ± SE). Hepatitis C, either alone or in part, was the etiology in 63{\%} of patients with HCC. The sensitivity of CT scan (88{\%}) was significantly higher than AFP > 20 ng/ml (62{\%}) and ultrasound (59{\%}) for detecting HCC (p < 0.001). CONCLUSIONS: In patients with established cirrhosis, the risk of detecting HCC is maximal at the baseline screening (7{\%}). Hepatitis C was the most common etiology for cirrhosis in study. In U.S. patients with established cirrhosis, CT scan exhibited higher sensitivity for detecting HCC than ultrasound or AFP.",
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AU - Said, Areen

AU - Hoen, Helena

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AU - Stockberger, Stephan M.

AU - Manam, Rajesh

AU - Kwo, Paul Y.

AU - Lumeng, Lawrence

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N2 - OBJECTIVE: Most available data on screening for hepatocellular carcinoma (HCC) in patients with cirrhosis originate from Asia and Europe. These data may not be applicable to patients from the United States because of geographic variation in the underlying etiology and other factors. Our aim was to assess the risk of HCC in U.S. patients with cirrhosis undergoing standardized screening. METHODS: All cirrhotic patients evaluated for liver transplantation at our institution from January 1, 1994-December 31, 1997 were included in this study. The screening strategy included initial screening, which was offered to all patients and consisted of alpha- fetoprotein (AFP), abdominal ultrasound, and computed tomography (CT) scan, and extended screening, which was performed only on transplant-eligible patients and consisted of semiannual AFP and ultrasound. RESULTS: During the study period, 285 patients with cirrhosis were evaluated for transplantation and underwent initial screening. Of these, 166 were eligible for transplantation and underwent extended screening during a median follow-up of 15 months (range 6-42 months). Twenty-seven HCC were found, 22 during initial screening and five during extended screening. The cancer-free proportions of the cohort who underwent extended screening at 1, 2, and 3.5 yr were 98.6% ± 1.4%, 96.4 ± 1.8%, and 77.1% ± 1.7%, respectively (mean ± SE). Hepatitis C, either alone or in part, was the etiology in 63% of patients with HCC. The sensitivity of CT scan (88%) was significantly higher than AFP > 20 ng/ml (62%) and ultrasound (59%) for detecting HCC (p < 0.001). CONCLUSIONS: In patients with established cirrhosis, the risk of detecting HCC is maximal at the baseline screening (7%). Hepatitis C was the most common etiology for cirrhosis in study. In U.S. patients with established cirrhosis, CT scan exhibited higher sensitivity for detecting HCC than ultrasound or AFP.

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