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Surveillance of hepatocellular carcinoma in patients with hepatitis C virus infection may improve patient survival


Hironori Tanaka, MD,
Department of Internal Medicine, Tsuyama Central Hospital, 1756 kawasaki, Tsuyama City, Okayama 708-0841, Japan.
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Abstract: Background: The benefit of surveillance of hepatocellular carcinoma (HCC) for patients with hepatitis C virus (HCV) infection, in terms of long-term survival, has not yet been established.

Methods: A total of 384 consecutive anti-HCV-positive HCC patients admitted to our hospital between January 1991 and October 2003 were enrolled. Patients were categorized into two groups, a surveillance group (182 patients) and a non-surveillance group (202 patients), according to tumor detection in a surveillance program based on periodical examination via ultrasound sonography and alpha fetoprotein determination at 6-month intervals, and their survival rates were compared.

Results: Although there were no significant differences in age and Child–Pugh classes between the two groups, the surveillance group exhibited a smaller tumor size (19 vs. 35 mm) and a higher incidence of single HCC (67% vs. 46%), compared with the non-surveillance group (each, P<0.001). The cumulative survival rate in the surveillance group was higher than that in the non-surveillance group (5 years survival, 46% vs. 32%, P<0.001). When the survival after correction of the lead-time bias in the surveillance group was analyzed according to the Child–Pugh classification, the surveillance program was found to have had a favorable outcome in Child–Pugh class A patients, but not in Child–Pugh class B/C patients.

Conclusions: HCC surveillance for patients with HCV infection can lead to discovery of tumors at an early stage, especially in Child–Pugh class A, resulting in a favorable outcome.