Researchers from the Virginia Commonwealth Medical Center have reported that the quality of surveillance in patients with cirrhosis has an impact on stage at diagnosis of hepatocellular carcinoma and survival from liver transplantation. The details of this retrospective study were published in the February 2008 issue of The American Journal of Medicine.¹

Liver cancer is a major worldwide problem with more than 1 million cases diagnosed per year. In the United States, the incidence of liver cancer is expected to rise because of the relatively large number of individuals with hepatitis C.

Liver cancers can be treated with surgery, embolism, chemotherapy, radiation therapy, and microwave hyperthermia. Because of the relatively advanced stage at presentation, most current therapies are palliative. The best therapy, especially for those with severe cirrhosis, may be liver transplantation. Liver transplantation has been used successfully to treat patients with relatively small hepatocellular carcinomas, and more recently, larger carcinomas have been treated successfully when multimodality adjuvant therapy is also administered.

There are no absolute criteria that patients must have to be eligible for a liver transplant, but better results are obtained in patients who have tumors less than five centimeters, less than three centimeters (if there are one to three tumors), and no invasion of blood vessels or lymph nodes. One of the major problems is that the transplant must be done promptly, before the eligible patient’s cancer progresses.

The role of early diagnosis has been stressed in the success of liver transplantation for hepatocellular carcinoma, but little has been reported about surveillance of at-risk populations. Researchers looked at the quality of surveillance in three groups of patients with cirrhosis and hepatocellular carcinoma:

1. Standard of care: 171 patients
2. Substandard surveillance: 48 patients
3. Absence of surveillance: 59 patients not recognized as having cirrhosis (subtle abnormalities of cirrhosis on lab tests)

These authors reported that the three-year survival of 60 patients undergoing liver transplantation was 81% compared with 12% for those not undergoing liver transplant. Patients with increasing tumor stage were less likely to undergo liver transplantation. For patients receiving standard-of-care surveillance, 70% were diagnosed with Stage I-II disease. For patients receiving substandard surveillance, 32% were diagnosed with Stage I-II disease. For patients receiving no surveillance, 18% were diagnosed with Stage I-II disease. Liver transplant was performed in 32% of patients with standard-of-care surveillance, while only 13% and 7%, respectively, of patients with substandard or no surveillance received a liver transplant. The three-year survival of patients with standard-of-care surveillance was 39% compared with 27% and 12%, respectively, for patients receiving suboptimal or no surveillance.

Comments: These authors suggest that quality of surveillance is related to early diagnosis of hepatocellular cancer. They also point out that many patients with hepatic cirrhosis are not being diagnosed by routine laboratory tests.

Related News:

Results of Liver Transplants for Patients with Hepatocellular Carcinoma are Improving (12/3/2003)

Hepatocellular Carcinoma Continues to Increase in the US (11/19/2003)

Adjuvant Therapy and Liver Transplantation Can Be Effective for Hepatocellular Carcinomas Larger Than Five Centimeters (5/9/2002)

Reference:

¹ Stravitz RT, Heuman DM, Chand N, et al. Surveillance for hepatocellular carcinoma in patients with cirrhosis improves outcome. The American Journal of Medicine. 2008;121:119-126.