Application of surveillance programs for hepatocellular carcinoma in the Asia–Pacific Region

Authors

  • Deepak Amarapurkar,

    Corresponding author
    1. Bombay Hospital and Medical Research Centre, Mumbai, India;
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  • Kwang-Hyub Han,

    1. Yonsei University College of Medicine, Seoul, Korea;
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  • Henry Lik-Yuen Chan,

    1. Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong SAR, China; and
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  • Yoshiyuki Ueno,

    1. Tohoku University Graduate School of Medicine, Japan
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  • The Asia-Pacific Working Party on Prevention of Hepatocellular Carcinoma

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    • 1

      Asia-Pacific Working Party on Prevention of Hepatocellular Carcinoma: Convenor: Geoffrey C Farrell, Australian National University Medical School, The Canberra Hospital, ACT, Australia; Co-convenor and secretary: Henry L-Y Chan, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Man-Fung Yuen, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong; Deepak N Amarapurkar, Bombay Hospital and Medical Research Center, Mumbai, India; Anuchit Chutaputti, Phramongkutklao Hospital, Thailand; Jian-Gao Fan and Jin-Lin Hou, Hepatology Unit, Nanfang Hospital, Guangzhou, China; Kwang-Hyub Han, Yonsei University College of Medicine, Seoul, Korea; Jia-Horng Kao, National Taiwan University College of Medicine, Taiwan; Seng-Gee Lim, National University Hospital, Singapore; Rosmawati Mohamed, University Malaya Medical Centre, Kuala Lumpur, Malaysia; Jose Sollano, University of Santo Tomas, Manila, Philippines; Yoshiyuki Ueno, Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.


Professor Deepak Amarapurkar, D 401/402 Ameya RBI Employees, Co-Op Housing Society, Plot No. 947-950, New Prabhadevi Road, Prabhadevi, Mumbai 400 025, India. Email: amarapurkar@gmail.com

Abstract

Hepatocellular carcinoma (HCC) is a potential target for cancer surveillance (or screening) as it occurs in well-defined, at-risk populations and curative therapy is possible only for small tumors. Surveillance has been recommended by regional liver societies and is practiced widely, but its benefits are not clearly established. Hepatic ultrasonography with or without alpha fetoprotein (AFP) performed every 6 months is the preferred program. Surveillance of HCC has been well shown to detect small tumors for curative treatment, which may be translated to improved patient survival. However, most studies are limited by lead-time bias, length bias for early diagnosis of small HCC, different tumor growth rates and poor compliance with surveillance. Cost-effectiveness of surveillance programs depends on the rate of small HCC detected ‘accidentally’ (routine imaging) in a comparator group, annual incidence of HCC with various etiologies, patient age and the availability of liver transplantation. The incremental cost-effectiveness for 6-monthly AFP and ultrasound has been estimated from approximately $US26 000–74 000/quality adjusted life years (QALY). All cirrhotic patients are therefore recommended for HCC surveillance unless the disease is too advanced for any curative treatment. As chronic hepatitis B can develop into HCC without going through liver cirrhosis, high-risk non-cirrhotic chronic hepatitis B patients are also recommended for HCC surveillance. In conclusion, HCC surveillance could be effective at reducing disease-specific mortality with acceptable cost-effectiveness among selected patient groups, provided it is a well-organized program.

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