An intensive screening program detected high incidence of hepatocellular carcinoma (HCC) in hepatitis B virus carriers (HBVC) with abnormal alfa-fetoprotein (AFP) or abdominal ultrasongraphy (AUS)

Abstract

4002 Background: Screening holds the promise to early detection and treatment of HCC. However, the efficacy in terms of decreasing disease-specific mortality and its cost-effectiveness remain controversial. Intensity of screening and selection of target patient group contribute to the success of such program. In this study we subjected hepatitis B virus carriers (HBVC) with at least 1 abnormal AFP or AUS to an intensive screening program and determine their prevalence and incidence of HCC. Methods: Enrollment criteria: age 40–70 years, HBsAg positive, Child-Pugh Liver Classification A or B. All patients were screened by serum AFP and AUS at enrollment. Patients with either AFP>20ng/dl or abnormal AUS were enrolled to an intensive program that screened patient with one or more hepatic angiogram plus lipiodol CT scan, followed by AFP/AUS every 3 months for 2 years then every 6 months. Patients with normal AFP/AUS were followed with AFP every 6 months and AUS repeated at the end of 2 years. Histology is the gold standard for diagnosis of HCC. Results: Between 10/97 and 11/00 we screened 1018 patients (m:f 688:330; mean age 48.4) and enrolled 171 patients (AFP+/AUS- 126; AFP-/AUS+ 38; AFP+/AUS+ 7) to the intensive screening program. After a median follow-up of 4.4 years we detected 47 HCCs (15 at enrollment and 32 during follow-up), giving a prevalence of 1473/100,000 (95%CI 858 to 2477 per 100,000) and annual incidence of 794/100,000 (95% CI 562 to 1122 per 100,000). 9 HCC were detected from 847 pts with normal AFP/AUS over 2 years giving an incidence of 223/100,000 (95% CI 116 to 429 per 100,000). Surgical resection: 17 cases. Main reasons for inoperability: poor liver function and multi-centric disease. Conclusion: An intensive screening program detects a high prevalence and incidence of HCC in HBVC with at least one abnormal AFP or AUS. Incidence of HCC is significantly lower in the population with normal screening AFP and AUS for 2 years. Survival data will be available for presentation. We acknowledge the Hong Kong Cancer Fund for support towards this project. No significant financial relationships to disclose.