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

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.

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: