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, 3:610

Medicine

Abstract

Hepatocellular carcinoma HCC is the third most common cause of cancer-related death worldwide, with an increased incidence in South Asia. In order to describe the effect of surveillance for HCC with biannual ultrasound and alpha-fetoprotein AFP on diagnosis and survival in an Indian population a retrospective cohort-control study was performed at two liver clinics in India. The medical records of 3,258 patients with cirrhosis who received surveillance for HCC were reviewed, and 100 patients who developed HCC identified. Sixty-four cirrhotic patients diagnosed with HCC during the same time period without a history of surveillance were included and survival, BCLC stage at diagnosis, and treatment were compared.

Patients who underwent surveillance were more likely to be diagnosed with potentially curable or treatable BCLC Stage 0-A disease and Stage B-C disease respectively, than late Stage D disease χ2 = 0.0007. Patients diagnosed at an earlier stage of HCC lived significantly longer after diagnosis than patients diagnosed at a later stage Stage 0-A: 15.6 ± 14.2 months vs. Stage B-C: 9.43 ± 19.7 months vs. Stage D: 5.59 ± 11.9 months; p = 0.0006. While treatment for HCC improved overall survival, only 28% of eligible patients received treatment, explaining the lack of survival benefit noted in the surveillance group. Surveillance for HCC led to detection of HCC at earlier stages. The impact of surveillance on improved mortality could not be evaluated given the limited number of patients who received treatment. HCC surveillance has the potential to improve survival in South Asian patients with cirrhosis only if improvements in access to appropriate treatment are made.

KeywordsHepatocellular carcinoma Surveillance Ultrasounds Survival Treatment India Electronic supplementary materialThe online version of this article doi:10.1186-2193-1801-3-610 contains supplementary material, which is available to authorized users.

Anita Kohli, Allison A Murphy contributed equally to this work.

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Author: Anita Kohli - Allison A Murphy - Chirdeep Agarwal - Bhavana Shivakumar - Shyam Kottilil - Michael A Polis - G Mani Subra

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