Does surveillance for hepatocellular carcinoma in HCV cirrhotic patients improve treatment outcome mainly due to better clinical status at diagnosis?

Background/Aims: Cirrhotic patients with hepatitis C virus infection are a group at higher risk. for hepatocellular carcinoma. Conventional screening programs detect only few early hepatocellular carcinomas that are eligible for radical treatment. Our aim was to compare characteristics of patients, modality of treatment, and outcome in anti-HCV positive cirrhotics with hep atocellular carcinoma diagnosed during follow-up, or incidentally. Methodology: Sixty-one hepatocellular carcinomas were consecutively diagnos ed in cirrhotic anti-HCV patients from 1993-1998 among which 34 during bian nual ultrasonographic-biochemical follow-up and the others incidentally. Ch ild-Pugh's score, a-fetoprotein levels, uni- or multifocality of the tumor, and treatment and survival of the patients were then analyzed on the basis of modality of diagnosis. Results: Surgical treatment was feasible only in a minority of patients. Ra dical and palliative treatment was more frequent among patients with HCC di agnosed during follow-up. Child-Pugh's score was lower in these patients, m oreover their survival rate was better. Analysis of survival of patients tr eated with the same procedure and grouped by modality of diagnosis did not demonstrate any differences. Regression analysis showed that patients with a lower Child-Pugh's score, one nodule, with a tumor diagnosed during follo w-up and who were treated had a better survival rate. Conclusions: In our population surveillance did not detect a higher percent age of curable HCC. Nevertheless the results of palliative treatment and of curative treatment overlapped. Overall better outcome was observed in pati ents with preserved liver function whatever the treatment. Surveillance all owed us to diagnose HCC in patients with these characteristics thus leading to an improved survival rate.