High prevalence of multinodular hepatocellular carcinoma in patients with cirrhosis attributable to multiple risk factors

To see whether or not there is an association between the cause of cirrhosi s and the number of hepatocellular carcinoma (HCC) nodules, we analyzed 178 consecutive patients in whom HCC was detected during a prospective screeni ng by abdominal ultrasound (US), The relevant information was obtained from the database of the screening programs operating at four hospitals in the Milan area. One hundred twenty-nine (72%) patients had a single tumor nodul e detected by US and 49 (28%) patients had multinodular disease. Ninety-eig ht (55%) patients had nor mal serum values of cu-fetoprotein (AFP). Tumor s taging with biphasic computed tomography (CT) scan or hepatic arteriography with lipiodol revealed that 101 (57%) patients had single tumor nodules an d 77 (43%) patients had more than one HCC nodule. After staging, multinodul ar HCC was more common in patients with multiple risk factors than in the h epatitis C virus (HCV) carriers (56% vs. 38%, P = .05). Interestingly, sing le tumors were as common in the 126 patients undergoing B-month interval sc reening as in the 52 patients who were studied at yearly intervals. The for mer patients, however, had more small tumors than the latter ones (91% vs. 74%, P = .04). The 22 patients who were alcohol abusers had normal levels o f serum AFP more often than the hepatitis B virus (HBV) or HCV carriers or those with multiple risk factors (86% vs. 57%, P < .04; vs. 47%, P < .002; vs. 52%, P < .006, respectively). We concluded that multinodular HCC was un derdetected by real time US; it prevailed among patients with multiple risk factors, In these patients, screening with US exams every 6 months may be inadequate for early detection of liver cancer.