J Liver Cancer.  2019 Mar;19(1):30-37. 10.17998/jlc.19.1.30.

Discrepancy between the Actual Clinical Status of Patients with Hepatocellular Carcinoma and Expectations from Hepatocellular Carcinoma Surveillance: a Single-Center Study

• Kim NM
• Doh YS
• Jang JW
• Kim SH
• Eun HS
• Jun JH
• Kim SH
• Baek IH
• Jung SH

• KMID: 2448274
• DOI: http://doi.org/10.17998/jlc.19.1.30

Abstract

BACKGROUND/AIMS
The National Liver Cancer Screening Program (NLCSP) has been implemented for the past 15 years in Korea. However, the actual clinical experience in Korea is inconsistent with the expectations of the hepatocellular carcinoma (HCC) surveillance program. To evaluate the actual clinical situation of HCC diagnoses, we investigated disease severity in patients with HCC and the diagnostic environment.
METHODS
From January 2011 to December 2015, all patients who were diagnosed with HCC in a single secondary hospital in Daejeon city were retrospectively enrolled in this study. Severity of HCC was evaluated according to the Barcelona Clinic Liver Cancer (BCLC) staging system.
RESULTS
Over the course of 5 years, 298 participants were enrolled. The mean age of participants was 64.0 years. Positive hepatitis B surface antigen was confirmed in 134 patients (45.0%), 35 patients (11.7%) tested positive for anti-hepatitis C virus antibody, and 93 patients (32.2%) had more than 40 g/day of alcohol consumption. The proportions of patients according to BCLC stages were as follows: BCLC-0, 28 patients (9.4%); BCLC-A, 42 patients (14.1%); BCLC-B, 26 patients (8.7%); BCLC-C, 134 patients (45.0%); and BCLC-D, 68 patients (22.8%). The diagnostic environments were as follows: 19 patients were in the NLCSP group (6.4%), 114 in the group with presenting signs (38.3%), 110 in the regular outpatient care group (36.9%), and 55 patients in the incidental diagnosis group (18.5%).
CONCLUSIONS
Most patients (67.8%) had advanced stage HCC at diagnosis, and curative treatment was not indicated due to the severity disease. Thus, the actual situation is far worse than the theoretical expectation of HCC surveillance, suggesting that many high-risk patients for HCC are missed in surveillance.

Keyword

Hepatocellular carcinoma; Surveillance; Mass screening; Chronic Hepatitis B; Epidemiology

MeSH Terms

Alcohol Drinking
Ambulatory Care
Carcinoma, Hepatocellular*
Diagnosis
Epidemiology
Hepatitis B Surface Antigens
Hepatitis B, Chronic
Humans
Korea
Liver Neoplasms
Mass Screening
Retrospective Studies
Hepatitis B Surface Antigens

Figure

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  Figure 1. Severity of patients HCC at diagnosis, according to BCLC stage. HCC, hepatocellular carcinoma; BCLC, Barcelona Clinic Liver Cancer.

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  Figure 2. Proportion of diagnostic environment types in each BCLC stage. BCLC, Barcelona Clinic Liver Cancer.

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