PROSPECTIVE-STUDY OF SCREENING FOR HEPATOCELLULAR-CARCINOMA IN CAUCASIAN PATIENTS WITH CIRRHOSIS

Screening is widely used to detect early hepatocellular carcinoma in A sian patients with cirrhosis. Its effectiveness in Caucasian patients has been suggested, but remains to be proven. Therefore we prospective ly studied 118 French patients (68 males, 50 females, age 55+/-12) wit h Child-Pugh A or B cirrhosis (alcoholic in 82) and without detectable hepatocellular carcinoma. The screening program consisted of ultrasou nd examination of the liver and determination of blood alphafetoprotei n and des-gamma-carboxyprothrombin levels every 6 months. The median f ollow up was 36 months (range 4-48). Only four patients were lost to f ollow up. Fourteen hepatocellular carcinomas were detected, in six cas es by ultrasonography alone, in four by alpha-fetoprotein alone, in th ree by ultrasonography and alpha-fetoprotein and in one case by ultras onography and des-gamma-carboxyprothrombin, but never by des-gamma-dar boxyprothrombin alone. The tumor presented as a unique nodule in nine patients. The tumor was less than 3 cm in diameter without portal thro mbosis or metastasis in three cases. Surgery was performed in only one case. In this study, the annual incidence of hepatocellular carcinoma was high (5.8%), but the screening methods used did not effectively i dentify potentially resectable tumors in Caucasian patients with cirrh osis. (C) Journal of Hepatology.