Clinical

Cancer surveillance futile in advanced cirrhosis

Last Updated: 2007-12-03 16:52:59 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Surveillance for the early diagnosis of hepatocellular carcinoma (HCC) in cirrhosis patients appears to be useful only for those in earlier stages of the disease, Italian researchers report in the November issue of the American Journal of Gastroenterology.

"This study clearly shows that surveillance becomes pointless if applied to patients who have reached an advanced stage of cirrhosis -- Child-Pugh class C -- and are not candidates for liver transplantation," lead investigator Dr. Franco Trevisani told Reuters Health.

In patients with advanced cirrhosis, hepatic failure usually makes cancer treatment too dangerous and treatment outcomes are poor. In addition, these patients also have a high rate of cirrhosis-related mortality.

To help refine surveillance selection criteria, Dr. Trevisani of the University of Bologna and colleagues studied data on 468 Child-Pugh class B and 140 class C patients.

HCC was diagnosed during annual or semiannual surveillance in 252 patients and was detected outside of routine surveillance in 356.

The team found that surveillance significantly improved the prognosis in class B patients, increasing survival by 5.1 months. Compared with controls, the number of radical treatments was doubled (35% versus 18%) and the number of patients considered untreatable was almost halved (29% versus 51%).

In the class C patients who were not candidates for liver transplantation, surveillance resulted in almost twice the rate of radical therapies. This figure is low, the investigators note. "Poor liver function likely worsened the treatment results and increased cirrhosis-related mortality."

The researchers conclude that surveillance is worthwhile in class B patients and should be maintained in class A patients migrating to class B. However, surveillance proves useful only for class C patients who are awaiting surgery.

Am J Gastroenterol 2007;102:2448-2457.