While it remains difficult to treat and long-term
survival rates are low, management
of HCC has improved in recent years with the advent of new treatments such
radiofrequency ablation (RFA) -- a method of destroying tumors with heat using
a high frequency current -- as well as wider availability of liver transplantation.
Successful management of HCC is typically limited by late diagnosis, but
this may be alleviated by screening high-risk patients for liver cancer using
methods such as alpha-fetoprotein (AFP) measurement, since early treatment leads
to better outcomes.
In a study described in the April 2008 Annals of
Surgery, researchers from Hong Kong evaluated the impact of improved surgical
management of liver cancer on the survival of patients who were screened for HCC.
The
investigators reviewed information from a prospective database of 1366 patients
with known chronic hepatitis B or C who were diagnosed with HCC either through
screening or based on symptomatic presentation between January 1991 and December
2004. Long-term survival of HCC patients in the screened and symptomatic groups
was compared.
In addition, the management and survival of patients in
two 7-year periods (1991-1997 vs 1998-2004) were also compared.
Results
•
Long-term survival with HCC was significantly better in the screened group compared
with the symptomatic group (median survival 61.9 vs 11.5 months; P < 0.001).
•
In the screened group, the proportion of patients who underwent curative treatment
increased from 50.5% during the 1991-1997 period to 67.8% during the 1998-2004
period.
•
There was no significant change, however, in the symptomatic group.
•
Improved long-term survival was observed in patients with HCC detected by screening
and treated in the second compared with the first period (median survival 68.5
vs 38.7 months, P = 0.022).
•
Again, no significant improvement was observed for the symptomatic patients.
Conclusion
Based
on these findings, the study authors concluded, "Survival of patients with
HCC detected by screening has improved in recent years due to increased chance
of curative treatment with the advent of liver transplantation and RFA."
04/22/08
Reference ACY
Chan, RTP Poon, KKC Ng, and others. Changing Paradigm in the Management of Hepatocellular
Carcinoma Improves the Survival Benefit of Early Detection by Screening. Annals
of Surgery 247(4):666-673. April 2008.
FDA-approved
Treatments
The
investigators reviewed information from a prospective database of 1366 patients
with known chronic hepatitis B or C who were diagnosed with HCC either through
screening or based on symptomatic presentation between January 1991 and December
2004. Long-term survival of HCC patients in the screened and symptomatic groups
was compared. 
Results
