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1. Pattern of macrovascular invasion in hepatocellular carcinoma

Author

Guarino, M., Cucchetti, A., Pontillo, G., Farinati, F., Benevento, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Rodolfo, S., Cabibbo, G., Marra, F., Mega, A., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Missale, G., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., Trevisani, F., Giannini, E. G., Morisco, F., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Neri, A., Rampoldi, D., Santi, V., Forgione, A., Granito, A., Muratori, L., Piscaglia, F., Sansone, V., Tovoli, F., Dajti, E., Marasco, G., Ravaioli, F., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Cela, E. M., Facciorusso, A., Pelizzaro, F., Imondi, A., Sartori, A., Penzo, B., Cacciato, V., Casagrande, E., Moscatelli, A., Pellegatta, G., Pieri, G., de Matthaeis, N., Allegrini, G., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Olivari, A., Inno, A., Marchetti, F., Busacca, A., Camma, C., Di Martino, V., Rizzo, G. E. M., Franze, M. S., Saitta, C., Sauchella, A., Bevilacqua, V., Borghi, A., Gardini, A. C., Conti, F., Berardinelli, D., Ercolani, G., Napoli, L., Campani, C., Di Bonaventura, C., Gitto, S., Coccoli, P., Malerba, A., Capasso, M., Fiorentino, A., Pignata, L., Cossiga, V., Romagnoli, V., Guarino M., Cucchetti A., Pontillo G., Farinati F., Benevento F., Rapaccini G.L., Di Marco M., Caturelli E., Zoli M., Rodolfo S., Cabibbo G., Marra F., Mega A., Gasbarrini A., Svegliati-Baroni G., Foschi F.G., Missale G., Masotto A., Nardone G., Raimondo G., Azzaroli F., Vidili G., Oliveri F., Trevisani F., Giannini E.G., Morisco F., Biselli M., Caraceni P., Garuti F., Gramenzi A., Neri A., Rampoldi D., Santi V., Forgione A., Granito A., Muratori L., Piscaglia F., Sansone V., Tovoli F., Dajti E., Marasco G., Ravaioli F., Cappelli A., Golfieri R., Mosconi C., Renzulli M., Cela E.M., Facciorusso A., Pelizzaro F., Imondi A., Sartori A., Penzo B., Cacciato V., Casagrande E., Moscatelli A., Pellegatta G., Pieri G., de Matthaeis N., Allegrini G., Lauria V., Ghittoni G., Pelecca G., Chegai F., Coratella F., Ortenzi M., Olivari A., Inno A., Marchetti F., Busacca A., Camma C., Di Martino V., Rizzo G.E.M., Franze M.S., Saitta C., Sauchella A., Bevilacqua V., Borghi A., Gardini A.C., Conti F., Berardinelli D., Ercolani G., Napoli L., Campani C., Di Bonaventura C., Gitto S., Coccoli P., Malerba A., Capasso M., Fiorentino A., Pignata L., Cossiga V., Romagnoli V., Guarino, M., Cucchetti, A., Pontillo, G., Farinati, F., Benevento, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Rodolfo, S., Cabibbo, G., Marra, F., Mega, A., Gasbarrini, A., Svegliati-Baroni, G., Foschi, F. G., Missale, G., Masotto, A., Nardone, G., Raimondo, G., Azzaroli, F., Vidili, G., Oliveri, F., Trevisani, F., Giannini, E. G., Morisco, F., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Neri, A., Rampoldi, D., Santi, V., Forgione, A., Granito, A., Muratori, L., Piscaglia, F., Sansone, V., Tovoli, F., Dajti, E., Marasco, G., Ravaioli, F., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Cela, E. M., Facciorusso, A., Pelizzaro, F., Imondi, A., Sartori, A., Penzo, B., Cacciato, V., Casagrande, E., Moscatelli, A., Pellegatta, G., Pieri, G., de Matthaeis, N., Allegrini, G., Lauria, V., Ghittoni, G., Pelecca, G., Chegai, F., Coratella, F., Ortenzi, M., Olivari, A., Inno, A., Marchetti, F., Busacca, A., Camma, C., Di Martino, V., Rizzo, G. E. M., Franze, M. S., Saitta, C., Sauchella, A., Bevilacqua, V., Borghi, A., Gardini, A. C., Conti, F., Berardinelli, D., Ercolani, G., Napoli, L., Campani, C., Di Bonaventura, C., Gitto, S., Coccoli, P., Malerba, A., Capasso, M., Fiorentino, A., Pignata, L., Cossiga, V., and Romagnoli, V.

Subjects
Ablation Techniques, Male, Registrie, Cirrhosis, Clinical Biochemistry, Mesenteric Vein, loco-regional treatment, 030204 cardiovascular system & hematology, Biochemistry, Gastroenterology, surgery, Antineoplastic Agent, Liver disease, 0302 clinical medicine, Non-alcoholic Fatty Liver Disease, cirrhosis, hepatocellular carcinoma, portal vein thrombosis, transplantation, Ascites, Ablation Technique, Registries, 030212 general & internal medicine, Chronic, Settore MED/12 - Gastroenterologia, Portal Vein, Liver Diseases, Liver Neoplasms, General Medicine, Middle Aged, Sorafenib, Prognosis, Hepatitis B, Alcoholic, Hepatitis C, Tumor Burden, Survival Rate, Italy, Liver Neoplasm, Hepatocellular carcinoma, Ascite, Female, medicine.symptom, Liver cancer, Human, medicine.medical_specialty, Carcinoma, Hepatocellular, Prognosi, Antineoplastic Agents, End Stage Liver Disease, 03 medical and health sciences, Mesenteric Veins, Hepatitis B, Chronic, Internal medicine, medicine, Humans, Hepatectomy, Neoplasm Invasiveness, portal vein thrombosi, Liver Diseases, Alcoholic, Aged, Neoplasm Invasivene, Performance status, business.industry, Carcinoma, Settore MED/09 - MEDICINA INTERNA, Patient Acuity, Hepatocellular, Hepatitis C, Chronic, medicine.disease, Liver Transplantation, Transplantation, Liver function, business, cirrhosi
Abstract

Background and aims: In patients with hepatocellular carcinoma (HCC), macrovascular invasion (MaVI) limits treatment options and decreases survival. Detailed data on the relationship between MaVI extension and patients' characteristics, and its impact on patients' outcome are limited. We evaluated the prevalence and extension of MaVI in a large cohort of consecutive HCC patients, analysing its association with liver disease and tumour characteristics, as well as with treatments performed and patients' survival. Methods: We analysed data of 4774 patients diagnosed with HCC recorded in the Italian Liver Cancer (ITA.LI.CA) database (2008-2018). Recursive partition analysis (RPA) was performed to evaluate interactions between MaVI, clinical variables and treatment, exploring the inter-relationship determining overall survival. Results: MaVI prevalence was 11.1%, and median survival of these patients was 6.0months (95% CI, 5.1-7.1). MaVI was associated with younger age at diagnosis, presence of symptoms, worse Performance Status (PS) and liver function, high alphafetoprotein levels and large HCCs. MaVI extension was associated with worse PS, ascites and greater impairment in liver function. RPA identified patients' categories with different treatment indications and survival, ranging from 2.4months in those with PS>1 and ascites, regardless of MaVI extension (receiving best supportive care in 90.3% of cases), to 14.1months in patients with PS 0-1, no ascites and Vp1-Vp2 MaVI (treated with surgery in 19.1% of cases). Conclusions: MaVI presence and extension, together with PS and ascites, significantly affect patients' survival and treatment selection. The decision tree based on these parameters may help assess patients' prognosis and inform therapeutic decisions.

Published
2021
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2. Estimation of lead-time bias and its impact on the outcome of surveillance for the early diagnosis of hepatocellular carcinoma

Author

Cucchetti A., Trevisani F., Pecorelli A., Erroi V., Farinati F., Ciccarese F., Rapaccini G. L., Di Marco M., Caturelli E., Giannini E. G., Zoli M., Borzio F., Cabibbo G., Felder M., Gasbarrini A., Sacco R., Foschi F. G., Missale G., Morisco F., Baroni G. S., Virdone R., Bernardi M., Pinna A. D., Bolondi L., Biselli M., Caraceni P., Garuti F., Gramenzi A., Lenzi B., Magalotti D., Piscaglia F., Serra C., Ravaioli M., Venerandi L., Del Poggio P., Olmi S., Balsamo C., Di Nolfo M. A., Vavassori E., Alberti A., Benvegnu L., Gatta A., Giacomin A., Vanin V., Pozzan C., Maddalo G., Giampalma E., Cappelli A., Golfieri R., Mosconi C., Renzulli M., Dell'Isola S., Ialungo A. M., Roselli P., Risso D., Marenco S., Sammito G., Bruzzone L., Bosco G., Grieco A., Pompili M., Rinninella E., Siciliano M., Chiaramonte M., Guarino M., Camma C., Maida M., Di Martino A., Barcellona M. R., Schiada L., Gemini S., Biasini E., Porro E., del Ricambio M., Mismas V., Vivaldi C., Cucchetti, A, Trevisani, F, Pecorelli, A, Erroi, V, Farinati, F, Ciccarese, F, Rapaccini, Gl, Di Marco, M, Caturelli, E, Giannini, Eg, Zoli, M, Borzio, F, Cabibbo, G, Felder, M, Gasbarrini, A, Sacco, R, Foschi, Fg, Missale, G, Morisco, Filomena, Baroni, G, Virdone, R, Bernardi, M, Pinna, Ad, Italian Liver Cancer, Group, Alessandro, Cucchetti, Franco, Trevisani, Anna, Pecorelli, Virginia, Erroi, Fabio, Farinati, Francesca, Ciccarese, Gian, Lodovico Rapaccini, Mariella Di, Marco, Eugenio, Caturelli, Edoardo, G. Giannini, Marco, Zoli, Franco, Borzio, Giuseppe, Cabibbo, Martina, Felder, Antonio, Gasbarrini, Rodolfo, Sacco, Francesco, Giuseppe Foschi, Gabriele, Missale, Filomena, Morisco, Gianluca, Svegliati Baroni, Roberto, Virdone, Mauro, Bernardi, Antonio D., Pinna, for the Italian Liver Cancer Group [.., Bolondi, Luigi, Maurizio, Biselli, Piscaglia, Fabio, ]., Cucchetti, A., Trevisani, F., Pecorelli, A., Erroi, V., Farinati, F., Ciccarese, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Giannini, E. G., Zoli, M., Borzio, F., Cabibbo, G., Felder, M., Gasbarrini, A., Sacco, R., Foschi, F. G., Missale, G., Morisco, F., Baroni, G. S., Virdone, R., Bernardi, M., Pinna, A. D., Bolondi, L., Biselli, M., Caraceni, P., Garuti, F., Gramenzi, A., Lenzi, B., Magalotti, D., Piscaglia, F., Serra, C., Ravaioli, M., Venerandi, L., Del Poggio, P., Olmi, S., Balsamo, C., Di Nolfo, M. A., Vavassori, E., Alberti, A., Benvegnu, L., Gatta, A., Giacomin, A., Vanin, V., Pozzan, C., Maddalo, G., Giampalma, E., Cappelli, A., Golfieri, R., Mosconi, C., Renzulli, M., Dell'Isola, S., Ialungo, A. M., Roselli, P., Risso, D., Marenco, S., Sammito, G., Bruzzone, L., Bosco, G., Grieco, A., Pompili, M., Rinninella, E., Siciliano, M., Chiaramonte, M., Guarino, M., Camma, C., Maida, M., Di Martino, A., Barcellona, M. R., Schiada, L., Gemini, S., Biasini, E., Porro, E., del Ricambio, M., Mismas, V., and Vivaldi, C.

Subjects
Male, medicine.medical_specialty, Pediatrics, Carcinoma, Hepatocellular, Time Factors, Hepatocellular carcinoma, Settore MED/12 - GASTROENTEROLOGIA, Disease, Gastroenterology, Bias, Internal medicine, Overall survival, medicine, Humans, Early Detection of Cancer, Aged, Estimation, Surveillance, Hepatology, business.industry, Liver Neoplasms, medicine.disease, digestive system diseases, Lead time bias, Cirrhosis, Female, business, Lead-time bias, Follow-Up Studies
Abstract

Lead-time is the time by which diagnosis is anticipated by screening/surveillance with respect to the symptomatic detection of a disease. Any screening program, including surveillance for hepatocellular carcinoma (HCC), is subject to lead-time bias. Data regarding lead-time for HCC are lacking. Aims of the present study were to calculate lead-time and to assess its impact on the benefit obtainable from the surveillance of cirrhotic patients. Background & Aims: Lead-time is the time by which diagnosis is anticipated by screening/surveillance with respect to the symptomatic detection of a disease. Any screening program, including surveillance for hepatocellular carcinoma (HCC), is subject to lead-time bias. Data regarding lead-time for HCC are lacking. Aims of the present study were to calculate lead-time and to assess its impact on the benefit obtainable from the surveillance of cirrhotic patients. Methods: One-thousand three-hundred and eighty Child–Pugh class A/B patients from the ITA.LI.CA database, in whom HCC was detected during semiannual surveillance (n = 850), annual surveillance (n = 234) or when patients came when symptomatic (n = 296), were selected. Lead-time was estimated by means of appropriate formulas and Monte Carlo simulation, including 1000 patients for each arm. Results: The 5-year overall survival after HCC diagnosis was 32.7% in semiannually surveilled patients, 25.2% in annually surveilled patients, and 12.2% in symptomatic patients (p

Published
2014

3. The VIRGO interferometer for gravitational wave detection RID C-9235-2011 RID B-5375-2009 RID A-1920-2008

Author

Caron, B, Dominjon, A, Drezen, C, Flaminio, R, Grave, X, Marion, F, Massonnet, L, Mehmel, C, Morand, R, Mours, B, Sannibale, V, Yvert, M, Babusci, D, Bellucci, S, Candusso, S, Giordano, G, Matone, G, Mackowski, Jm, Pinard, L, Barone, F, Calloni, E, Difiore, L, Flagiello, M, Garuti, F, Grado, A, Longo, M, Lops, M, Marano, S, Milano, L, Solimeno, S, Brisson, V, Cavalier, F, Davier, M, Hello, P, Heusse, P, Mann, P, Acker, Y, Barsuglia, M, Bhawal, B, Bondu, F, Brillet, A, Heitmann, H, Innocent, Jm, Latrach, L, Man, Cn, Phamtu, M, Tournier, E, Taubmann, M, Vinet, Jy, Boccara, C, Gleyzes, P, Loriette, V, Roger, Jp, Cagnoli, G, Gammaitoni, L, Kovalik, J, Marchesoni, F, Punturo, M, Beccaria, M, Bernardini, M, Bougleux, E, Braccini, S, Bradaschia, C, Cella, G, Ciampa, A, Cuoco, E, Curci, G, Delfabbro, R, Desalvo, R, Divirgilio, A, Enard, D, Ferrante, Isidoro, Fidecaro, Francesco, Giassi, A, Giazotto, A, Holloway, L, Lapenna, P, Losurdo, G, Mancini, S, Mazzoni, M, Palla, F, Pan, Hb, Passuello, D, Pelfer, P, Poggiani, Rosa, Stanga, R, Vicere, A, Zhang, Z, Ferrari, V, Majorana, E, Puppo, P, Rapagnani, P, and Ricci, F.

Published
1997

4. Opioid receptors in human neoplasms: growth hormone and prolactin response to morphine, met-enkephalin and buprenorphine in cancer patients

Author

Astuti R, Tancini G, Barni S, Paolo Lissoni, and Garuti F

Subjects
Met-enkephalin, Adult, Male, Cancer Research, medicine.medical_specialty, Time Factors, Enkephalin, Methionine, Injections, Subcutaneous, Clinical Biochemistry, Radioimmunoassay, Growth hormone, 030218 nuclear medicine & medical imaging, Pathology and Forensic Medicine, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Internal medicine, Neoplasms, medicine, Humans, Receptor, Aged, Morphine, business.industry, Cancer, Middle Aged, medicine.disease, Prolactin, Buprenorphine, Endocrinology, Oncology, Opioid, chemistry, 030220 oncology & carcinogenesis, Growth Hormone, Injections, Intravenous, Receptors, Opioid, Female, business, medicine.drug
Published
1989

5. Comparison between alcohol- and hepatitis C virus-related hepatocellular carcinoma: clinical presentation, treatment and outcome

Author

BUCCI, LAURA, GARUTI, FRANCESCA, LENZI, BARBARA, PISCAGLIA, FABIO, ZOLI, MARCO, BERNARDI, MAURO, TREVISANI, FRANCO, BOLONDI, LUIGI, BISELLI, MAURIZIO, CARACENI, PAOLO, CUCCHETTI, ALESSANDRO, DOMENICALI, MARCO, GRAMENZI, ANNAGIULIA, Camelli, V, Farinati, F, Giannini, E, Ciccarese, F, Rapaccini, G, Di Marco, M, Caturelli, E, Borzio, F, Sacco, R, Maida, M, Felder, M, Morisco, F, Gasbarrini, A, Gemini, S, Foschi, F, Missale, G, Masotto, A, Affronti, A, Italian Liver Cancer Group, Bucci, L., Garuti, F., Camelli, V., Lenzi, B., Farinati, F., Giannini, E. G., Ciccarese, F., Piscaglia, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Sacco, R., Maida, M., Felder, M., Morisco, F., Gasbarrini, A., Gemini, S., Foschi, F. G., Missale, G., Masotto, A., Affronti, A., Bernardi, M., Trevisani, F, Olmi, S, on behalf of Italian Liver Cancer, (ITA. LI. CA) Group., Bucci, L, Garuti, F, Camelli, V, Lenzi, B, Farinati, F, Giannini, E, Ciccarese, F, Piscaglia, F, Rapaccini, G, Di Marco, M, Caturelli, E, Zoli, M, Borzio, F, Sacco, R, Maida, M, Felder, M, Morisco, F, Gasbarrini, A, Gemini, S, Foschi, F, Missale, G, Masotto, A, Affronti, A, Bernardi, M, Italian Liver Cancer (ITA.LI.CA.) Group, Bolondi, L, Biselli, M, Caraceni, P, Cucchetti, A, Domenicali, M, Gramenzi, A, Giannini, E. G, Rapaccini, G. L, Morisco, Filomena, Foschi, F. G, and Trevisani, F.

Subjects
Male, Sex Factor, Gastroenterology, Hepatitis, 0302 clinical medicine, alcoholic cirrhosi, Liver Function Tests, Retrospective Studie, Risk Factors, Esophageal and Gastric Varice, 80 and over, Age Factor, Pharmacology (medical), Age Factors, Aged, Aged, 80 and over, Carcinoma, Hepatocellular, Esophageal and Gastric Varices, Female, Hepatitis C, Hepatitis, Alcoholic, Humans, Liver Neoplasms, Middle Aged, Neoplasm Staging, Prognosis, Proportional Hazards Models, Retrospective Studies, Sex Factors, Treatment Outcome, Venous Thrombosis, alpha-Fetoproteins, Medicine (all), medicine.diagnostic_test, Liver Function Test, Alcoholic, Liver Neoplasm, Hepatocellualr carinoma, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, epidemiology, 030211 gastroenterology & hepatology, Liver cancer, Viral hepatitis, Human, medicine.medical_specialty, Prognosi, 03 medical and health sciences, Internal medicine, medicine, Venous Thrombosi, Hepatology, business.industry, Risk Factor, Carcinoma, Cancer, Hepatocellular, medicine.disease, digestive system diseases, BCLC Stage, Proportional Hazards Model, Liver function, business, Liver function tests, HCV-related cirrhosi
Abstract

Summary Background Hepatitis C virus (HCV) and alcohol abuse are the main risk factors for hepatocellular carcinoma (HCC) in Western countries. Aim To investigate the role of alcoholic aetiology on clinical presentation, treatment and outcome of HCC as well as on each Barcelona Clinic Liver Cancer (BCLC) stage, as compared to HCV-related HCCs. Methods A total of 1642 HCV and 573 alcoholic patients from the Italian Liver Cancer (ITA.LI.CA) database, diagnosed with HCC between January 2000 and December 2012 were compared for age, gender, type of diagnosis, tumour burden, portal vein thrombosis (PVT), oesophageal varices, liver function tests, alpha-fetoprotein, BCLC, treatment and survival. Aetiology was tested as predictor of survival in multivariate Cox regression models and according to HCC stages. Results Cirrhosis was present in 96% of cases in both groups. Alcoholic patients were younger, more likely male, with HCC diagnosed outside surveillance, in intermediate/terminal BCLC stage and had worse liver function. After adjustment for the lead-time, median (95% CI) overall survival (OS) was 27.4 months (21.5–33.2) in alcoholic and 33.6 months (30.7–36.5) in HCV patients (P = 0.021). The prognostic role of aetiology disappeared when survival was assessed in each BCLC stage and in the Cox regression multivariate models. Conclusions Alcoholic aetiology affects survival of HCC patients through its negative effects on secondary prevention and cancer presentation but not through a greater cancer aggressiveness or worse treatment result. In fact, survival adjusted for confounding factors was similar in alcoholic and HCV patients.

Published
2015

6. Alpha-fetoprotein for Diagnosis, Prognosis, and Transplant Selection

Author

Andrea Neri, Franco Trevisani, Francesca Garuti, Trevisani F., Garuti F., and Neri A.

Subjects
0301 basic medicine, Oncology, medicine.medical_specialty, Carcinoma, Hepatocellular, medicine.medical_treatment, Liver transplantation, Chronic liver disease, Risk Assessment, Sensitivity and Specificity, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Biomarkers, Tumor, medicine, Humans, Mass Screening, Stage (cooking), Mass screening, Hepatology, business.industry, Liver Neoplasms, Cancer, hepatocellular carcinoma, medicine.disease, digestive system diseases, Liver Transplantation, Tumor Burden, diagnosi, α-fetoprotein, 030104 developmental biology, Liver Neoplasm, Hepatocellular carcinoma, Biomarker (medicine), 030211 gastroenterology & hepatology, alpha-Fetoproteins, Neoplasm Recurrence, Local, Alpha-fetoprotein, business, prognosi, Human
Abstract

Reliable biomarkers are of great clinical value in predicting cancer occurrence/recurrence, anticipating its detection at an asymptomatic stage, supporting the radiological diagnosis, stratifying patients for prognosis and proper therapy, and measuring the response to treatment. Despite the plethora of biomarkers proposed for hepatocellular carcinoma (HCC), the first one identified, α-fetoprotein (AFP), remains the most utilized. This article reviews the lights and shadows of AFP as a surveillance test for patients at risk of HCC, and as a diagnostic test for those with chronic liver disease and a suspected hepatic mass. Moreover, the article scrutinizes the large body of evidence supporting the prognostic relevance of AFP in patients undergoing both curative and palliative treatment of HCC and the growing importance attributed to this biomarker (as a static or a dynamic variable) in the selection of potential candidates for liver transplantation. In fact, the inclusion of AFP among transplant criteria would improve the ability of identifying poor candidates due to an unacceptable risk of HCC recurrence regardless of tumor burden, and of adopting flexible morphological selection criteria.

Published
2019
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7. Surveillance for early diagnosis of hepatocellular carcinoma: How best to do it?

Author

Alessandro Cucchetti, Francesca Garuti, Virginia Erroi, Federica Odaldi, Edoardo G. Giannini, Franco Trevisani, Giannini EG, Cucchetti A, Erroi V, Garuti F, Odaldi F, and Trevisani F.

Subjects
medicine.medical_specialty, Carcinoma, Hepatocellular, Time Factors, Hepatocellular carcinoma, Cost effectiveness, Cost-Benefit Analysis, Malignancy, Chronic liver disease, Risk Assessment, Predictive Value of Tests, Risk Factors, Cancer screening, Biopsy, medicine, Humans, Topic Highlight, Intensive care medicine, Early Detection of Cancer, Neoplasm Staging, Ultrasonography, Surveillance, medicine.diagnostic_test, business.industry, Patient Selection, Liver Neoplasms, Gastroenterology, Health Care Costs, General Medicine, medicine.disease, digestive system diseases, Surgery, Cost-effectivene, Population Surveillance, Predictive value of tests, Screening, Risk assessment, business
Abstract

Surveillance for hepatocellular carcinoma (HCC) is considered a standard of care for patients with chronic liver disease who are at risk of developing this malignancy. Several studies have shown that surveillance can improve the prognosis of patients diagnosed with HCC through an increased likelihood of application of curative or effective treatments. Repetition of liver ultrasonography (US) every 6 mo is the recommended surveillance program to detect early HCCs, and a positive US has to entrain a well-defined recall policy based on contrast-enhanced, dynamic radiological imaging or biopsy for the diagnosis of HCC. Although HCC fulfills the accepted criteria regarding cost-effective cancer screening and surveillance, the implementation of surveillance in clinical practice is defective and this has a negative impact on the cost-effectiveness of the procedure. Education of both physicians and patients is of paramount importance in order to improve the surveillance application and its benefits in patients at risk of HCC. The promotion of specific educational programs for practitioners, clinicians and patients is instrumental in order to expand the correct use of surveillance in clinical practice and eventually improve HCC prognosis.

Published
2013
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