Effectiveness of Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis
Menée sur 446 patients présentant une cirrhose classée A ou B selon l'indice de CHILD, cette étude évalue l'efficacité d'un programme de surveillance incluant une échographie et / ou un dosage sanguin de l'alpha-fœtoprotéine pour détecter précocement un carcinome hépatocellulaire
Background: Surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis, but the effectiveness of a surveillance program in clinical practice has yet to be established. Aims: To evaluate the effectiveness of a surveillance program with ultrasound and alpha fetoprotein (AFP) to detect early HCC. Methods: 446 patients with Child A/B cirrhosis were prospectively enrolled between 1/04-9/06 and followed until 7/10. HCC surveillance using ultrasound and AFP was performed per the treating hepatologist, though the standard was every 6-12 months. HCC was diagnosed using AASLD guidelines and early HCC defined by BCLC staging. Performance characteristics were determined for surveillance using AFP, ultrasound, or the combination. Results: After a median follow-up of 3.5 years, 41 patients developed HCC, of whom 30 (73.2%) had early HCC. The annual incidence of HCC was 2.8%, with cumulative 3- and 5-year incidence rates of 5.7% and 9.1% respectively. Surveillance ultrasound and AFP had sensitivities of 44% and 66% and specificities of 92% and 91% respectively for the detection of HCC. Sensitivity significantly improved to 90%, with minimal loss in specificity (83%) when these tests were used in combination. Conclusions: When employed as a surveillance program in a real-world clinical setting, combination ultrasound and AFP is the most effective strategy to detect HCC at an early stage. Impact: Our results differ from the guidelines of the American Association for the Study of Liver Disease.
Cancer Epidemiology Biomarkers & Prevention , résumé, 2012