Screening for hepatocellular carcinoma in patients with advanced cirrhosis

OBJECTIVE: Most available data on screening for hepatocellular carcinoma (H CC) in patients with cirrhosis originate from Asia and Europe. These data m ay not be applicable to patients from the United States because of geograph ic variation in the underlying etiology and other factors. Our him was to a ssess the risk of HCC in U.S. patients with cirrhosis undergoing standardiz ed screening. METHODS: All cirrhotic patients evaluated for liver transplantation at our institution from January 1, 1994 -December 31, 1997 were included in this s tudy. The screening strategy included initial screening, which was offered to all patients and consisted of alpha-fetoprotein (AFP), abdominal ultraso und, and computed tomography (CT) scan, and extended screening, which was p erformed only on transplant-eligible patients and consisted of semiannual A FP and ultrasound. RESULTS: During the study period, 285 patients with cirrhosis were evaluate d for transplantation and underwent initial screening. Of these, 166; were eligible for transplantation and underwent extended screening during a medi an 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, a nd 3.5 yr were 98.6% +/- 1.4%, 96.4 +/- 1.8%, and 77.1% +/- 1.7%, respectiv ely (mean +/- SE). Hepatitis C, either alone or in part, was the etiology i n 63% of patients with HCC. The sensitivity of CT scan (88%) was significan tly 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 com mon etiology for cirrhosis in study. In U.S. patients with established cirr hosis, CT scan exhibited higher sensitivity for detecting HCC than ultrasou nd or AFP. (C) 1999 by Am. Coll. of Gastroenterology.