PROSPECTIVE-STUDY OF EARLY DETECTION FOR PRIMARY LIVER-CANCER

Purpose: To determine whether repeated screening can lead to early det ection of primary liver cancer (PLC) and in turn to an improved clinic al result. Methods: In this randomized controlled study, Shanghai urba n residents aged 35-55 years and with serum evidence of HBV infection or chronic liver disease were eligible for recruitment. Using cluster sampling, these subjects were allocated into two groups - the screenin g group and the control group: there were 8109 subjects in the screeni ng group and 9711 in the control group. Subjects in the screening grou p were tested with serum AFP and real-time ultrasound every 6 months. One to four rounds of screening were completed. Liver cancer was treat ed according to stage at diagnosis. Results: All subjects enrolled wer e followed up and classed at the end-point as alive without liver canc er, alive with liver cancer, dead from liver cancer, or dead from anot her cause. The mean follow-up was 1.2 years; total followup was 12,038 person-years in the screening group and 9,573 person-years in the con trol group. We detected 38 patients with PLC in the screening group an d 18 patients with PLC in the control group. In the patients in the sc reening group 76.8% of patients were at a subclinical stage, and 70.6% of them underwent resection, the 1- and 2-year survival rates being 8 8.1% and 77.5%, respectively. However, in the control group, none of t he patients was at a subclinical stage when diagnosed, none of them un derwent resection, and none of them survived over 1 year. The lead tim e was estimated at 0.45 years. The cost of detecting PLC at an early s tage was RMB 12,600 (US$ 1,500). Conclusion: The study proved that scr eening the high-risk population for PLC with a serum AFP test and real -time ultrasound examination can detect patients in the early stages, increase the resection rate and prolong the survival time. It is there fore recommended that screening for PLC be advocated in any high-risk area.