Early detection of hepatocellular carcinoma increases the chance of treatment: Hong Kong experience

The prognosis for patients with hepatocellular carcinoma (HCC) is poor beca use of the low chance of curative treatment. To increase the chance of inte rvention and to improve survival, early detection of subclinical HCC (SCHCC ) by alpha-fetoprotein (AFP) and/or ultrasonography (USG) screening is impl emented in many countries. Three hundred six Chinese patients with HCC diag nosed between January 1995 and December 1997 were recruited. They were cate gorized into two groups: 142 patients (group 1) had SCHCC diagnosed by scre ening (AFP and/or USG), and 164 patients (group 2) presented with symptomat ic HCC. The tumor size was significantly smaller in group 1 compared with t hat of group 2 (3.5 cm vs. 8.1 cm; P < .0001), A significantly higher propo rtion of patients had bilobar involvement, multifocal HCC, diffuse-type HCC , portal vein infiltration, and distant metastasis in group 2 when compared with group 1. Operability and feasibility of treatment by transcatheter in tra-arterial chemoembolization (TACE) in group 1 patients (26.8% and 45.1%, respectively) were significantly better than in group 2 patients (7.9% and 32.3%, P < .0001 and P = .03, respectively). The cumulative survival rare was significantly higher in group 1 than in group 2 (P < .0001), For those who had surgical resection and those who had TACE, group 1 patients had a h igher cumulative survival rate compared with that of group 2 patients (P = .04 and P = .0003, respectively). Screening for HCC by AFP and/or USG can i dentify tumors at an tarry stage, resulting in a higher chance of receiving treatment. Whether it can improve survival requires a further prospective, randomized study.