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Clin Mol Hepatol ; 23(3): 239-248, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28706177

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.


Subject(s)
Carcinoma, Hepatocellular/pathology , Liver Neoplasms/pathology , Adult , Age Factors , Aged , Aged, 80 and over , Body Mass Index , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/diagnostic imaging , Early Detection of Cancer , Female , Humans , Hyperlipidemias/complications , Liver Cirrhosis/complications , Liver Neoplasms/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Population Surveillance , Retrospective Studies , Risk Factors , Smoking/epidemiology , Ultrasonography , alpha-Fetoproteins/analysis
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