Screening for hepatocellular carcinoma

摘要

Screening for hepatocellular carcinoma in patients with chronic liver disease has been a controversial issue, despite the devastating outcome associated with delayed diagnosis. The only means to improve outcomes is by earlier diagnosis with regular surveillance of patients at greatest risk for this complication, namely those with cirrhosis and those with chronic hepatitis B infection. Established screening tests are serum alpha fetoprotein measurement and abdominal ultrasound. The optimal screening interval is six months, based on the average tumour doubling time. Recent studies have confirmed that screening does lead to the detection of hepatocellular carcinoma at an early stage when curative therapy is possible. Survival from the time of diagnosis is improved in screen-detected hepatocellular carcinomas, compared to incidentally detected tumours. In the only randomised control study of surveillance for hepatocellular carcinoma in a population with endemic hepatitis B virus infection, screening was also associated with an overall reduction in mortality from hepatocellular carcinoma. Screening for hepatocellular carcinoma does meet the cost-effectiveness threshold in both the cirrhotic and the chronic hepatitis B virus populations, although the inclusion of transplantation in the latter impacts negatively on cost-effectiveness. Screening for hepatocellular carcinoma is justified in both patients with cirrhosis and those with chronic hepatitis B virus infection.