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Hepatol Int. 2013 Oct;7(4):1010-8. doi: 10.1007/s12072-013-9462-z. Epub 2013 Jul 27.

Incidence and risk factors for surveillance failure in patients with regular hepatocellular carcinoma surveillance.

Author information

1
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
2
Department of Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, South Korea.
3
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea. drmschoi@gmail.com.
4
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

Abstract

BACKGROUND:

Initial presentation of hepatocellular carcinoma (HCC) at an advanced stage in patients under a regular surveillance program is a devastating problem.

AIMS:

We assessed the prevalence and factors associated with this surveillance failure.

METHODS:

A total of 304 HCC patients who received regular surveillance were retrospectively reviewed. Surveillance failure was defined when the tumor was diagnosed at beyond the Milan criteria.

RESULTS:

Surveillance failure rate was 5.9 %. Macronodular cirrhosis (MC), ultrasonography-only surveillance (US-S) and infiltrative tumor type were independent factors associated with surveillance failure. The surveillance failure rate was higher in patients with MC (10.3 vs. 3.2 %, p = 0.022), US-S (14.6 vs. 4.3 %, p = 0.013) and when the tumor was infiltrative type (57.1 vs. 2.1 %, p < 0.001). Based on the two baseline factors (MC and US-S), the surveillance failure rates were 35.7, 6.8, 5.9 and 2.6 % for MC(+)/US-S(+), MC(+)/US-S(-), MC(-)/US-S(+) and MC(-)/US-S(-), respectively (p < 0.001).

CONCLUSION:

The HCC surveillance failure was not rare in clinical practice. These data suggest that special attention for surveillance failure might be needed for patients with MC who receive US-S.

KEYWORDS:

Alpha-fetoprotein; Failure; Hepatocellular carcinoma; Surveillance; Ultrasonography

PMID:
26202030
DOI:
10.1007/s12072-013-9462-z

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