Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome

Richard Todd Stravitz, Douglas M. Heuman, Nisha Chand, Richard K. Sterling, Mitchell L. Shiffman, Velimir A. Luketic, Arun J. Sanyal, Adil Habib, Anastasios A. Mihas, Ho Chong S Giles, Daniel Maluf, Adrian H. Cotterell, Marc P. Posner, Robert A. Fisher

Research output: Contribution to journalArticle

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Abstract

Objective: Liver transplantation has become an effective treatment for cirrhotic patients with early-stage hepatocellular carcinoma. We hypothesized that the quality of surveillance for hepatocellular carcinoma influences prognosis by affecting access to liver transplantation. Methods: A total of 269 patients with cirrhosis and hepatocellular carcinoma were retrospectively categorized into 3 groups according to quality of surveillance: standard-of-care (n = 172) (group 1); substandard surveillance (n = 48) (group 2); and absence of surveillance in patients not recognized to be cirrhotic (n = 59) (group 3). Results: Three-year survival in the 60 patients who underwent liver transplantation was 81% versus 12% for patients who did not undergo transplantation (P <.001). The percentages of patients who underwent transplantation according to tumor stage at diagnosis (T1, T2, T3, and T4) were 58%, 35%, 10%, and 1%, respectively. Hepatocellular carcinoma was diagnosed at stages 1 and 2 in 70% of patients in group 1, 37% of patients in group 2, and only 18% of patients in group 3 (P <.001). Liver transplantation was performed in 32% of patients in group 1, 13% of patients in group 2, and 7% of patients in group 3 (P <.001). Three-year survival from cancer diagnosis in patients in group 3 (12%) was significantly worse than in patients in group 1 (39%) or group 2 (27%) (each P <.05). Eighty percent of patients in group 3 had subtle abnormalities of cirrhosis on routine laboratory tests. Conclusion: The quality of surveillance has a direct impact on hepatocellular carcinoma stage at diagnosis, access to liver transplantation, and survival.

Original languageEnglish (US)
Pages (from-to)119-126
Number of pages8
JournalAmerican Journal of Medicine
Volume121
Issue number2
DOIs
StatePublished - Feb 1 2008
Externally publishedYes

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Hepatocellular Carcinoma
Fibrosis
Liver Transplantation
Survival
Transplantation
Standard of Care
Neoplasms

All Science Journal Classification (ASJC) codes

  • Nursing(all)

Cite this

Stravitz, R. T., Heuman, D. M., Chand, N., Sterling, R. K., Shiffman, M. L., Luketic, V. A., ... Fisher, R. A. (2008). Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome. American Journal of Medicine, 121(2), 119-126. https://doi.org/10.1016/j.amjmed.2007.09.020

Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome. / Stravitz, Richard Todd; Heuman, Douglas M.; Chand, Nisha; Sterling, Richard K.; Shiffman, Mitchell L.; Luketic, Velimir A.; Sanyal, Arun J.; Habib, Adil; Mihas, Anastasios A.; Giles, Ho Chong S; Maluf, Daniel; Cotterell, Adrian H.; Posner, Marc P.; Fisher, Robert A.

In: American Journal of Medicine, Vol. 121, No. 2, 01.02.2008, p. 119-126.

Research output: Contribution to journalArticle

Stravitz, RT, Heuman, DM, Chand, N, Sterling, RK, Shiffman, ML, Luketic, VA, Sanyal, AJ, Habib, A, Mihas, AA, Giles, HCS, Maluf, D, Cotterell, AH, Posner, MP & Fisher, RA 2008, 'Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome', American Journal of Medicine, vol. 121, no. 2, pp. 119-126. https://doi.org/10.1016/j.amjmed.2007.09.020
Stravitz RT, Heuman DM, Chand N, Sterling RK, Shiffman ML, Luketic VA et al. Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome. American Journal of Medicine. 2008 Feb 1;121(2):119-126. https://doi.org/10.1016/j.amjmed.2007.09.020
Stravitz, Richard Todd ; Heuman, Douglas M. ; Chand, Nisha ; Sterling, Richard K. ; Shiffman, Mitchell L. ; Luketic, Velimir A. ; Sanyal, Arun J. ; Habib, Adil ; Mihas, Anastasios A. ; Giles, Ho Chong S ; Maluf, Daniel ; Cotterell, Adrian H. ; Posner, Marc P. ; Fisher, Robert A. / Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome. In: American Journal of Medicine. 2008 ; Vol. 121, No. 2. pp. 119-126.
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abstract = "Objective: Liver transplantation has become an effective treatment for cirrhotic patients with early-stage hepatocellular carcinoma. We hypothesized that the quality of surveillance for hepatocellular carcinoma influences prognosis by affecting access to liver transplantation. Methods: A total of 269 patients with cirrhosis and hepatocellular carcinoma were retrospectively categorized into 3 groups according to quality of surveillance: standard-of-care (n = 172) (group 1); substandard surveillance (n = 48) (group 2); and absence of surveillance in patients not recognized to be cirrhotic (n = 59) (group 3). Results: Three-year survival in the 60 patients who underwent liver transplantation was 81{\%} versus 12{\%} for patients who did not undergo transplantation (P <.001). The percentages of patients who underwent transplantation according to tumor stage at diagnosis (T1, T2, T3, and T4) were 58{\%}, 35{\%}, 10{\%}, and 1{\%}, respectively. Hepatocellular carcinoma was diagnosed at stages 1 and 2 in 70{\%} of patients in group 1, 37{\%} of patients in group 2, and only 18{\%} of patients in group 3 (P <.001). Liver transplantation was performed in 32{\%} of patients in group 1, 13{\%} of patients in group 2, and 7{\%} of patients in group 3 (P <.001). Three-year survival from cancer diagnosis in patients in group 3 (12{\%}) was significantly worse than in patients in group 1 (39{\%}) or group 2 (27{\%}) (each P <.05). Eighty percent of patients in group 3 had subtle abnormalities of cirrhosis on routine laboratory tests. Conclusion: The quality of surveillance has a direct impact on hepatocellular carcinoma stage at diagnosis, access to liver transplantation, and survival.",
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T1 - Surveillance for Hepatocellular Carcinoma in Patients with Cirrhosis Improves Outcome

AU - Stravitz, Richard Todd

AU - Heuman, Douglas M.

AU - Chand, Nisha

AU - Sterling, Richard K.

AU - Shiffman, Mitchell L.

AU - Luketic, Velimir A.

AU - Sanyal, Arun J.

AU - Habib, Adil

AU - Mihas, Anastasios A.

AU - Giles, Ho Chong S

AU - Maluf, Daniel

AU - Cotterell, Adrian H.

AU - Posner, Marc P.

AU - Fisher, Robert A.

PY - 2008/2/1

Y1 - 2008/2/1

N2 - Objective: Liver transplantation has become an effective treatment for cirrhotic patients with early-stage hepatocellular carcinoma. We hypothesized that the quality of surveillance for hepatocellular carcinoma influences prognosis by affecting access to liver transplantation. Methods: A total of 269 patients with cirrhosis and hepatocellular carcinoma were retrospectively categorized into 3 groups according to quality of surveillance: standard-of-care (n = 172) (group 1); substandard surveillance (n = 48) (group 2); and absence of surveillance in patients not recognized to be cirrhotic (n = 59) (group 3). Results: Three-year survival in the 60 patients who underwent liver transplantation was 81% versus 12% for patients who did not undergo transplantation (P <.001). The percentages of patients who underwent transplantation according to tumor stage at diagnosis (T1, T2, T3, and T4) were 58%, 35%, 10%, and 1%, respectively. Hepatocellular carcinoma was diagnosed at stages 1 and 2 in 70% of patients in group 1, 37% of patients in group 2, and only 18% of patients in group 3 (P <.001). Liver transplantation was performed in 32% of patients in group 1, 13% of patients in group 2, and 7% of patients in group 3 (P <.001). Three-year survival from cancer diagnosis in patients in group 3 (12%) was significantly worse than in patients in group 1 (39%) or group 2 (27%) (each P <.05). Eighty percent of patients in group 3 had subtle abnormalities of cirrhosis on routine laboratory tests. Conclusion: The quality of surveillance has a direct impact on hepatocellular carcinoma stage at diagnosis, access to liver transplantation, and survival.

AB - Objective: Liver transplantation has become an effective treatment for cirrhotic patients with early-stage hepatocellular carcinoma. We hypothesized that the quality of surveillance for hepatocellular carcinoma influences prognosis by affecting access to liver transplantation. Methods: A total of 269 patients with cirrhosis and hepatocellular carcinoma were retrospectively categorized into 3 groups according to quality of surveillance: standard-of-care (n = 172) (group 1); substandard surveillance (n = 48) (group 2); and absence of surveillance in patients not recognized to be cirrhotic (n = 59) (group 3). Results: Three-year survival in the 60 patients who underwent liver transplantation was 81% versus 12% for patients who did not undergo transplantation (P <.001). The percentages of patients who underwent transplantation according to tumor stage at diagnosis (T1, T2, T3, and T4) were 58%, 35%, 10%, and 1%, respectively. Hepatocellular carcinoma was diagnosed at stages 1 and 2 in 70% of patients in group 1, 37% of patients in group 2, and only 18% of patients in group 3 (P <.001). Liver transplantation was performed in 32% of patients in group 1, 13% of patients in group 2, and 7% of patients in group 3 (P <.001). Three-year survival from cancer diagnosis in patients in group 3 (12%) was significantly worse than in patients in group 1 (39%) or group 2 (27%) (each P <.05). Eighty percent of patients in group 3 had subtle abnormalities of cirrhosis on routine laboratory tests. Conclusion: The quality of surveillance has a direct impact on hepatocellular carcinoma stage at diagnosis, access to liver transplantation, and survival.

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