Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B

Department of Family Medicine, University of Calgary, Calgary, Canada.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 09/2012; 9(9):CD002799. DOI: 10.1002/14651858.CD002799.pub2
Source: PubMed


Liver cancer is a leading cause of death among people with chronic hepatitis B infection. Screening such patients with ultrasound of the liver or alpha-foetoprotein in the blood, or both, is widely performed to detect liver cancer at an early stage. The hope is that early stages of liver cancer can be treated by resection or transplantation, or both, with improved outcomes. Only three trials could be included in this review. One of these trials was conducted in Shanghai, China. It compared screening twice yearly with ultrasound and alpha-foetoprotein against no screening. The trial has a high risk of systematic errors (bias) and several published reports of the trial provide different results. Another trial was conducted in Toronto, Canada. It compared screening with alpha-foetoprotein and ultrasound versus screening with alpha-foetoprotein alone. This trial had too few participants. As there were no participants who were not screened, we cannot assess whether screening is effective in reducing mortality. The remaining trial was published as an abstract only. It was designed to determine the optimal time interval for screening using alpha fetoprotein and ultrasound. The cumulative four-year survival was not significantly different between the two studied screening intervals of four months and 12 months. Thus, to date, there is insufficient evidence regarding screening for liver cancer among patients with chronic hepatitis B infection.

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    • "The diagnosis of HCC without pathologic confirmation can be achieved by assessing the serum alpha-fetoprotein (AFP) level combined with imaging techniques, including ultrasonography, magnetic resonance imaging, and computerized tomography [31,32]. However, improvement in early diagnosis is still needed because only 44% of the patients are diagnosed at a localized disease stage, and only 30% of patients with HCC are candidates for potentially curative treatments at the time of diagnosis [33]. "
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    ABSTRACT: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world. Currently, surgical resection, liver transplantation, and local ablation are considered curative therapeutic practices for HCC. The diagnosis of HCC without pathologic confirmation is achieved by analyzing serum alpha-fetoprotein (AFP) levels combined with imaging techniques, including ultrasonography, magnetic resonance imaging, and computerized tomography. Although progress has been made in the diagnosis and management of HCC, its prognosis remains dismal. Various new technologies have identified numerous novel biomarkers with potential diagnostic as well as prognostic value, including Dickkopf-1 and Golgi protein 73. These biomarkers not only help in the early diagnosis and prediction of prognosis, but also assist in identifying potential targets for therapeutic interventions. In this article, we provide an up-to-date review of the biomarkers that are used for early diagnosis, prognosis prediction, and personalized treatment of HCC.
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    • "Hepatocellular carcinoma (HCC) is the most common primary malignant liver tumor and usually occurs in the setting of cirrhosis and chronic hepatitis B and C infections. Earlier detection of HCC allows initiation of curative therapy and for this, surveillance in cirrhotic patients is performed with alpha-fetoprotein testing and sonography.[8] Sonographic features of HCC are variable with sensitivity as low as 20.5%[9] to as high as 81%.[10] "
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