Hepatocellular carcinoma screening: Difference between revisions
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==Overview== | ==Overview== | ||
"Surveillance is deemed cost-effective if the expected HCC risk exceeds 1.5% per year in patients with hepatitis C and 0.2% per year in patients with hepatitis B. Analysis of recent studies show that alpha-fetoprotein determination lacks adequate sensitivity and specificity for effective surveillance (and for diagnosis). Thus, surveillance has to be based on ultrasound examination. The recommended screening interval is 6 months" according to a [[clinical practice guideline]] by the [http://www.aasld.org/ American Association for the Study of Liver Diseases]. <ref name="pmid21374666"/> | "Surveillance is deemed cost-effective if the expected HCC risk exceeds 1.5% per year in patients with hepatitis C and 0.2% per year in patients with hepatitis B. Analysis of recent studies show that alpha-fetoprotein determination lacks adequate sensitivity and specificity for effective surveillance (and for diagnosis). Thus, surveillance has to be based on ultrasound examination. The recommended screening interval is 6 months" according to a [[clinical practice guideline]] by the [http://www.aasld.org/ American Association for the Study of Liver Diseases].<ref name="pmid21374666">{{cite journal| author=Bruix J, Sherman M, American Association for the Study of Liver Diseases| title=Management of hepatocellular carcinoma: an update. | journal=Hepatology | year= 2011 | volume= 53 | issue= 3 | pages= 1020-2 | pmid=21374666 | doi=10.1002/hep.24199 | pmc=PMC3084991 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21374666 }} </ref> | ||
"In a mixed-aetiology cohort, the most effective surveillance strategy is to screen each patient with AFP assay and ultrasound imaging on a 6-monthly basis" according to a [[systematic review]] by the [http://www.hta.ac.uk/ NIHR Health Technology Assessment programme] (UK). <ref name="pmid17767898"/> | "In a mixed-aetiology cohort, the most effective surveillance strategy is to screen each patient with AFP assay and ultrasound imaging on a 6-monthly basis" according to a [[systematic review]] by the [http://www.hta.ac.uk/ NIHR Health Technology Assessment programme] (UK).<ref name="pmid17767898">{{cite journal| author=Thompson Coon J, Rogers G, Hewson P, Wright D, Anderson R, Cramp M et al.| title=Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis. | journal=Health Technol Assess | year= 2007 | volume= 11 | issue= 34 | pages= 1-206 | pmid=17767898 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17767898 }} </ref> | ||
==Evidence from trials== | ==Evidence from trials== | ||
Regarding patients with [[hepatitis B]], a [[meta-analysis]] by the [[Cochrane Collaboration]] concluded "".<ref name="pmid22972059">{{cite journal| author=Aghoram R, Cai P, Dickinson JA| title=Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B. | journal=Cochrane Database Syst Rev | year= 2012 | volume= 9 | issue= | pages= CD002799 | pmid=22972059 | doi=10.1002/14651858.CD002799.pub2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22972059 }} </ref> In a [[randomized controlled trial]] included in the meta-analysis, the [[relative risk ratio]] of biannual [[alpha-fetoprotein]] and [[ultrasonography]], as compared to [[no screening]], for mortality from hepatocellular carcinoma was 0.6 and the [[relative risk reduction]] was 36.7%. In populations similar to those in this study which had a rate of risk as measured by the mortality from hepatocellular carcinoma of 0.13% without treatment, the [[number needed to treat]] is 2070. <ref name="pmid15042359"/> | Regarding patients with [[hepatitis B]], a [[meta-analysis]] by the [[Cochrane Collaboration]] concluded "".<ref name="pmid22972059">{{cite journal| author=Aghoram R, Cai P, Dickinson JA| title=Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B. | journal=Cochrane Database Syst Rev | year= 2012 | volume= 9 | issue= | pages= CD002799 | pmid=22972059 | doi=10.1002/14651858.CD002799.pub2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22972059 }} </ref> In a [[randomized controlled trial]] included in the meta-analysis, the [[relative risk ratio]] of biannual [[alpha-fetoprotein]] and [[ultrasonography]], as compared to [[no screening]], for mortality from hepatocellular carcinoma was 0.6 and the [[relative risk reduction]] was 36.7%. In populations similar to those in this study which had a rate of risk as measured by the mortality from hepatocellular carcinoma of 0.13% without treatment, the [[number needed to treat]] is 2070.<ref name="pmid15042359">{{cite journal| author=Zhang BH, Yang BH, Tang ZY| title=Randomized controlled trial of screening for hepatocellular carcinoma. | journal=J Cancer Res Clin Oncol | year= 2004 | volume= 130 | issue= 7 | pages= 417-22 | pmid=15042359 | doi=10.1007/s00432-004-0552-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15042359 }} </ref> | ||
Revision as of 13:33, 5 October 2012
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Hepatocellular carcinoma Microchapters |
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Differentiating Hepatocellular carcinoma from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Hepatocellular carcinoma screening On the Web |
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American Roentgen Ray Society Images of Hepatocellular carcinoma screening |
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Risk calculators and risk factors for Hepatocellular carcinoma screening |
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Overview
"Surveillance is deemed cost-effective if the expected HCC risk exceeds 1.5% per year in patients with hepatitis C and 0.2% per year in patients with hepatitis B. Analysis of recent studies show that alpha-fetoprotein determination lacks adequate sensitivity and specificity for effective surveillance (and for diagnosis). Thus, surveillance has to be based on ultrasound examination. The recommended screening interval is 6 months" according to a clinical practice guideline by the American Association for the Study of Liver Diseases.[1]
"In a mixed-aetiology cohort, the most effective surveillance strategy is to screen each patient with AFP assay and ultrasound imaging on a 6-monthly basis" according to a systematic review by the NIHR Health Technology Assessment programme (UK).[2]
Evidence from trials
Regarding patients with hepatitis B, a meta-analysis by the Cochrane Collaboration concluded "".[3] In a randomized controlled trial included in the meta-analysis, the relative risk ratio of biannual alpha-fetoprotein and ultrasonography, as compared to no screening, for mortality from hepatocellular carcinoma was 0.6 and the relative risk reduction was 36.7%. In populations similar to those in this study which had a rate of risk as measured by the mortality from hepatocellular carcinoma of 0.13% without treatment, the number needed to treat is 2070.[4]
References
- ↑ Bruix J, Sherman M, American Association for the Study of Liver Diseases (2011). "Management of hepatocellular carcinoma: an update". Hepatology. 53 (3): 1020–2. doi:10.1002/hep.24199. PMC 3084991. PMID 21374666.
- ↑ Thompson Coon J, Rogers G, Hewson P, Wright D, Anderson R, Cramp M; et al. (2007). "Surveillance of cirrhosis for hepatocellular carcinoma: systematic review and economic analysis". Health Technol Assess. 11 (34): 1–206. PMID 17767898.
- ↑ Aghoram R, Cai P, Dickinson JA (2012). "Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B." Cochrane Database Syst Rev. 9: CD002799. doi:10.1002/14651858.CD002799.pub2. PMID 22972059.
- ↑ Zhang BH, Yang BH, Tang ZY (2004). "Randomized controlled trial of screening for hepatocellular carcinoma". J Cancer Res Clin Oncol. 130 (7): 417–22. doi:10.1007/s00432-004-0552-0. PMID 15042359.