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Surveillance Suggested for Childs-Pugh Class B Cirrhosis Patients, Not Childs-Pugh Class C Cirrhosis Patients

February 23, 2008
Written by: , Filed in: Abdominal Imaging
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The objective of a recent study was to assess whether surveillance programs for hepatocellular carcinoma (HCC) in patients with C-P class B and class C cirrhosis offer a survival benefit.

The study has concluded that despite the earlier detection in patients with Childs-Pugh (C-P) class C cirrhosis, mortality is not significantly improved, as underlying liver function will determine survival in these patients.

Methodology
608 patients who met eligibility criteria were selected from the Italian Liver Cancer (ITA.LI.CA) database. Eligibility requirements included a description of the interval of surveillance and the C-P class at the time of diagnosis with HCC. The patients were divided into two groups.

Group 1 included 252 patients whose HCC was found during regular surveillance. Their diagnosis was made based on ultrasound and alpha-fetoprotein done every six months or every 12 months.

Group 2 was composed of 356 cases whose HCC was found “incidentally” outside of any programmed surveillance, or during examinations for other diseases. Histology and cytology were utilized for diagnosing HCC; ultrasound and CT scanning, or MRI (and, when appropriate, angiography) were used for staging.

Related CME:
NEW FOR 2009
Abdominal & Thoracic CT/MR/US: Optimizing Practice
The University of California, San Francisco School of Medicine
Evolving technology improves radiological practice through improved image quality for anatomical interpretation and generation of functional data. The use of MDCT and fast, multi-phase imaging sequences also translates to a tremendous increase in data that requires review and handling and greater need for contrast and radiation safety awareness. This activity targets the community radiologist involved in body and cardiovascular imaging with a focus on developing an efficient workflow practice in the modern imaging environment.
Read more or order: Abdominal & Thoracic CT/MR/US: Optimizing Practice

CT/MRI of the Abdomen and Pelvis
University of California San Francisco Department of Radiology and Biomedical Imaging
Provides an updated review on the use of helical (single and multidetector-row) CT and MRI for imaging of the abdomen and pelvis. Participants will learn the current approach and uses of CT/MRI in the examination of the abdomen and pelvis including advances in abdominal MRI techniques, genitourinary applications of CT/MRI, CT colonoscopy, CT/MR angiography, and CT cholangiography.
Earn up to 12 AMA PRA Category 1 Credits™.
Abdominal Imaging CME

Results of the Study
Patients selected over the seven-year period from the ITA.LI.CA database included 468 patients with C-P class B cirrhosis and 140 patients with C-P class C cirrhosis, including 1834 patients diagnosed with HCC. A total of 252 patients had HCC detected on surveillance programs (group 1) and 352 patients had HCC detection outside surveillance programs (group 2).

In regard to C-P class B, cancer stage and treatment distribution were better for group 1 patients versus group 2 patients, with a 5.1-month improved median survival.

For C-P class C patients, cancer stage and treatment distribution were also better for group 1 patients than for group 2 patients. However, this did not translate into improved survival in this group.

Conclusions
The authors recommend offering a surveillance program for C-P class B cirrhotic patients and not for C-P class C patients, except for those patients who are candidates for liver transplantation.

Author: Sohail Contractor, MD

Reference
Trevisani F, Santi V, et al. Surveillance of Early Diagnosis of Hepatocellular Carcinoma: Is it Effective in Intermediate/Advanced Cirrhosis?
Am J Gastroenterol; 2007; 102 (November): 2448-2457:

Related CME:
NEW FOR 2009
Abdominal & Thoracic CT/MR/US: Optimizing Practice
The University of California, San Francisco School of Medicine
Evolving technology improves radiological practice through improved image quality for anatomical interpretation and generation of functional data. The use of MDCT and fast, multi-phase imaging sequences also translates to a tremendous increase in data that requires review and handling and greater need for contrast and radiation safety awareness. This activity targets the community radiologist involved in body and cardiovascular imaging with a focus on developing an efficient workflow practice in the modern imaging environment.
Read more or order: Abdominal & Thoracic CT/MR/US: Optimizing Practice

CT/MRI of the Abdomen and Pelvis
University of California San Francisco Department of Radiology and Biomedical Imaging
Provides an updated review on the use of helical (single and multidetector-row) CT and MRI for imaging of the abdomen and pelvis. Participants will learn the current approach and uses of CT/MRI in the examination of the abdomen and pelvis including advances in abdominal MRI techniques, genitourinary applications of CT/MRI, CT colonoscopy, CT/MR angiography, and CT cholangiography.
Earn up to 12 AMA PRA Category 1 Credits™.
Abdominal Imaging CME
.

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