Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome

Section of Hepatology, Hume-Lee Transplant Center of Virginia Commonwealth University, Richmond, VA 23298-0341, USA.
The American journal of medicine (Impact Factor: 5). 02/2008; 121(2):119-26. DOI: 10.1016/j.amjmed.2007.09.020
Source: PubMed


Liver transplantation has become an effective treatment for cirrhotic patients with early-stage hepatocellular carcinoma. We hypothesized that the quality of surveillance for hepatocellular carcinoma influences prognosis by affecting access to liver transplantation.
A total of 269 patients with cirrhosis and hepatocellular carcinoma were retrospectively categorized into 3 groups according to quality of surveillance: standard-of-care (n=172) (group 1); substandard surveillance (n=48) (group 2); and absence of surveillance in patients not recognized to be cirrhotic (n=59) (group 3).
Three-year survival in the 60 patients who underwent liver transplantation was 81% versus 12% for patients who did not undergo transplantation (P<.001). The percentages of patients who underwent transplantation according to tumor stage at diagnosis (T1, T2, T3, and T4) were 58%, 35%, 10%, and 1%, respectively. Hepatocellular carcinoma was diagnosed at stages 1 and 2 in 70% of patients in group 1, 37% of patients in group 2, and only 18% of patients in group 3 (P <.001). Liver transplantation was performed in 32% of patients in group 1, 13% of patients in group 2, and 7% of patients in group 3 (P<.001). Three-year survival from cancer diagnosis in patients in group 3 (12%) was significantly worse than in patients in group 1 (39%) or group 2 (27%) (each P<.05). Eighty percent of patients in group 3 had subtle abnormalities of cirrhosis on routine laboratory tests.
The quality of surveillance has a direct impact on hepatocellular carcinoma stage at diagnosis, access to liver transplantation, and survival.

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    • "Although recent advances in dynamic imaging techniques, including computed tomography and magnetic resonance imaging, have facilitated the detection of small and early-stage HCC [7]–[9], the relative high cost and risks associated with these techniques limit their use. Because patients with advanced HCC generally have a poor prognosis, detection of early-stage HCC is the best strategy to improve outcomes [10], [11]. In this regard, there is urgent need to identify more sensitive and reliable serum biomarkers for detection of HCC. "
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    ABSTRACT: The α-fetoprotein fraction L3 (AFP-L3), which is synthesized by malignant cells and incorporates a fucosylated oligosaccharide, has been investigated as a diagnostic and prognostic marker for hepatocellular carcinoma (HCC). Quantification of AFP-L3 by conventional enzyme-linked immunosorbent assay (ELISA) has not always produced reliable results for serum samples with low AFP, and thus we evaluated the clinical utility of quantifying AFP-L3 using a new and highly sensitive glycan microarray assay. Sera from 9 patients with chronic hepatitis B and 32 patients with hepatitis B virus (HBV)-related HCC were tested for AFP-L3 level using the glycan microarray. Additionally, we compared receiver operator characteristic curves for the ELISA and glycan microarray methods for determination of the AFP-L3: AFP-L1 ratio in patient samples. This ratio was calculated for 8 HCC patients who underwent transarterial embolization therapy pre- or post-treatment with AFP-L3. Glycan microarrays showed that the AFP-L3 ratio of HBV-related HCC patients was significantly higher than that measured for chronic hepatitis B patients. Overall parameters for estimating AFP-L3% in HCC samples were as follows: sensitivity, 53.13%; specificity, 88.89%; and area under the curve, 0.75. The elevated AFP-L3% in the 8 patients with HBV-related HCC was strongly associated with HCC progression. Following one month of transarterial embolization therapy, the relative mean AFP-L3% decreased significantly. In addition, we compared Fut8 gene expression between paired tumor and non-tumor tissues from 24 patients with HBV-related HCC. The Fut8 mRNA expression was significantly increased in tumorous tissues in these patients than that in non-tumor tissue controls. Higher expression of Fut8 mRNA in tumorous tissues in these patients was associated with poor differentiation than well and moderate differentiation. Our results describe a new glycan microarray for the sensitive and rapid quantification of fucosylated AFP; this method is potentially applicable to screening changes in AFP-L3 level for assessment of HCC progression.
    PLoS ONE 06/2014; 9(6):e99959. DOI:10.1371/journal.pone.0099959 · 3.23 Impact Factor
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    • "Because the poor outcomes of HCC patients are often related to late detection, recent practice guidelines recommend continued surveillance for patients at high risk.3,4 Screening procedures for HCC include serological and radiological tests, and among the serological tests, α-fetoprotein (AFP) and prothrombin induced by vitamin K absence II (PIVKA II) are widely used as biomarkers for HCC.5-8 "
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    ABSTRACT: α-Fetoprotein (AFP) is the biomarker most widely used to detect hepatocellular carcinoma (HCC), despite its suboptimal diagnostic accuracy. Glypican-3 (GPC3) and osteopontin (OPN) are secreted glycoproteins that are reportedly associated with tumorigenesis and metastasis. This study was conducted to evaluate the clinical utility of using plasma GPC3 and OPN as diagnostic biomarkers for HCC. We measured the plasma levels of GPC3 and OPN in 120 HCC and 40 chronic liver disease (CLD) patients via an enzyme-linked immunosorbent assay. The diagnostic accuracy of each tumor marker was evaluated using receiver operating characteristic (ROC) curve analysis. The GPC3 levels in the HCC patients (75.8 ng/mL) were significantly higher (p=0.020) than the levels in patients with CLD (66.4 ng/mL). The area under the ROC curve (AUROC) values for GPC3 and OPN were 0.62 and 0.51, respectively. In subgroup analyses, including subgroups of HCC patients with low serum AFP and PIVKA II levels, the AUROC of GPC3 remained relatively high (0.66), and GPC3 showed a high sensitivity (62.1%) for detecting small HCC tumors. The plasma levels of GPC3 and OPN demonstrated low diagnostic accuracy for HCC. However, GPC3 may have a complementary role in diagnosing HCC in patients with nondiagnostic levels of conventional tumor markers and with small-sized tumors.
    Gut and Liver 03/2014; 8(2):177-85. DOI:10.5009/gnl.2014.8.2.177 · 1.81 Impact Factor
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    • "The prognosis of HCC patients still remains unsatisfactory , the 5-year survival rate being less than 10% both in Europe [4] and the USA [5]. Surveillance of patients at risk of developing HCC, based on the periodic repetition of liver ultrasound (US), makes it possible to detect most cancers at an early stage, still amenable to curative treatments which can greatly improve the prognosis of these individuals [6] [7] [8] [9] [10]. Therefore, regular surveillance of patients at risk of HCC is currently recommended by both Western [11] and Eastern [12] [13] practical guidelines for HCC management. "

    Digestive and Liver Disease 02/2011; 43(02). DOI:10.1016/S1590-8658(11)60094-7 · 2.96 Impact Factor
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