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Shorter surveillance periods detected smaller HCC in patients with viral hepatitis

Hepatocellular carcinoma ultrasonography surveillance conducted at 4-month intervals resulted in greater detection of smaller tumors among viral hepatitis patients than examination performed at 12-month intervals, according to study data.

In a community study in Taiwan, 744 adult patients with chronic viral hepatitis and thrombocytopenia were enrolled and randomly assigned to either 4-month (group A, n=387) or 12-month (group B, n=357) surveillance intervals to detect newly developed hepatocellular carcinoma (HCC). Surveillance was performed a mean of 7.13 and 2.53 times per patient in groups A and B, respectively, during the study that ran from April 2006 to September 2010.

Ultrasonography diagnosed HCC in 24 participants in group A and 15 in group B. Although 3-year cumulative incidence of HCC detection was similar between groups — 11.7% for group A, 9.7% for group B (P=.198) — smaller tumors were detected among 4-month surveillance patients (P=.006). HCC diameters in group A patients were a mean of 1.9 cm ± 0.7 cm vs. 2.9 cm ± 1.5 cm in group B, and more detected tumors were 2 cm or smaller in group A than in group B (P=.003). More patients in the 4-month surveillance interval group (37.5% vs. 6.7%) also had Barcelona Clinic Liver Cancer (BCLC) very-early stage (P=.017).

Using multivariate analysis, associated risk factors for HCC occurrence were male sex (HR=2.05; 95% CI, 1.05-4.01), liver cirrhosis (HR=23.3; 95% CI, 7.10-76.49) and platelet counts of less than 100 (x109)/L (HR=2.15; 95% CI, 1.13-4.08). Both groups showed no difference in overall survival at 4 years of follow-up, while patients who underwent recommended resection, radiofrequency ablation or transarterial embolization had better 4-year survival rates (P=.013).

“There was no difference in the detection rate of HCC between 4- and 12-month US surveillance intervals for patients with chronic viral hepatitis and thrombocytopenia,” the researchers concluded. “Compared with 12-month intervals, 4-month US surveillance intervals detected more patients with HCC 2 cm or less and in BCLC very-early stage for whom curative therapies might yield the best effects.”