Community-Based Mass Ultrasonographic Screening of Hepatocellular Carcinoma among Thrombocytopenic Adults

Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.13). 07/2008; 17(7):1813-21. DOI: 10.1158/1055-9965.EPI-07-2746
Source: PubMed


Thrombocytopenia has been reported as a valid surrogate for liver cirrhosis and could be used to identify groups at high risk of hepatocellular carcinoma (HCC) for ultrasonographic (US) screening. We designed this two-stage community-based screening for HCC. In 2004, subjects (ages > or =40 years) were invited to undergo comprehensive health examinations, with 17,551 men (ages 63.0 +/- 11.5 years) and 39,151 women (ages 59.9 +/- 11.7 years) participating. Subjects with platelet counts <150 x 10(9)/L or alpha-fetoprotein (AFP) >20 ng/mL were enrolled for the second-stage US screening; 3,242 subjects (5.7%; male/female, 1,415/1,827; age 66 +/- 10 years) were candidates for US screening and 2,983 (92.2%) responded. Of 137 suspected cases, 124 (90.5%) complied with referral for confirmation and 72 (58.1%) were confirmed to be HCC cases (male/female, 41/31; age 68.1 +/- 8.8 years). Screening with AFP, thrombocytopenia, or both could identify 0.64% (n = 364), 5.33% (n = 3,205), and 5.7% (n = 3,242) of the high-risk subjects from the population, estimated to include 50.5%, 54.5%, and 71.3% of all HCC cases. Among confirmed patients, tumor diameters were <3 cm for the 27 (37.5%) patients and 3 to 5 cm for the 23 (31.9%) patients. Only 5 (6.9%) patients' conditions were too advanced to be actively treated. This study enrolled only 5.7% of the participants for US, which cover 64.7% to 71.3% of the HCC cases. Most (93%) of the detected cases were caught early enough to undergo effective treatment modalities. This HCC screening protocol should be feasible, economical, and effective.

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    ABSTRACT: Sequelae of chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection, including hepatocellular carcinoma (HCC), liver cirrhosis (LC) and their complications, are health burdens of the world. Improving treatment results for early stage HCC makes the screening meaningful. Two-staged HCC screening identifying high risk subjects in the first stage and screening for HCC by ultrasonography (US) in the second stage is a practical and workable concept. The benefit of US screening on high risk groups has been well documented, but “who should be included in the US screening” depends on cost-benefits and considerations of feasibility.
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    ABSTRACT: Background The long-term trend of platelet count in chronic hepatitis C virus patients with sustained virological response (SVR) has rarely been investigated. Aims To elucidate changes of thrombocytopenia after SVR, trajectory patterns of platelet count over time and their associated factors. Methods From May 1999 to July 2005, a total of 135 patients (mean age 50.2 ± 11.1 years) that received interferon-α based regimen plus ribavirin were enrolled. Platelet counts were followed every 6 months prospectively. The patterns of platelet counts over time were identified by trajectory analysis. Results Mean follow-up duration was 4.4 ± 1.7 years (median 4.5; range 1.0–8.5 years). Baseline platelet count in all and thrombocytopenic patients increase significantly at the end of follow-up, from 172 ± 56 × 109/l and 115 ± 21 × 109/l to 196 ± 57 × 109/l and 148 ± 37 × 109/l, respectively (all p < 0.001). In patients with advanced fibrosis (n = 50), pretreatment platelet count also increased significantly (146 ± 45 × 109/l vs. 173 ± 51 × 109/l, p < 0.001). Twenty-six of 37 (69.2 %) patients with pretreatment mild thrombocytopenia (100–150 × 109/l) had normalization of platelet count, while seven of 13 (53.8 %) patients with pretreatment moderate to severe thrombocytopenia (<100 × 109/l) had elevation of platelet count up to 100–150 × 109/l. Three trajectory groups were identified, i.e., elevation (n = 43, 31.9 %), stationary (n = 79, 58.5 %), and decrease (n = 13, 9.6 %) groups. Multiple logistic regression showed pretreatment thrombocytopenia was the factor in elevation of platelet count (OR = 2.28, 95 % confidence interval = 1.01–5.11, p = 0.046). Conclusions Platelet count increased significantly in patients with SVR after long-term follow-up. Patients with low baseline platelet count benefit more from SVR with respect to increased platelet count, compared to those with higher platelet count at baseline.
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