Small Hepatocellular Carcinoma in Chinese Patients

Abstract

Physicians aim to either prevent HCC by treating the underlying cause or to diagnose it at its earliest, clinically-observable stages by surveillance, for maximal treatment benefit. Surveillance depends predominantly on radiological screening and less satisfactorily on AFP blood tests. We previously examined a large cohort of unresectable HCC patients and found some useful, statistically-significant, prognostic factors. We evaluated 325 Chinese HCC patients with hepatitis and were diagnosed with small HCCs by surveillance in Taiwan and we examined their clinical characteristics at time of HCC diagnosis, after ordering the patients according to their tumor mass and then analyzing trends in the data. We found that gender is associated with tumor mass and the patterns are different in patients with HBV or HCV. Male gender and young age were typical for smaller tumor mass phenotypes, but there was no gender bias for larger or multiple tumor phenotypes. Typical serum GGTP and ALKP levels increased linearly with tumor mass, but the AFP patterns were more complex. The relationship of serum AFP to GGTP and of albumin to bilirubin, help identify tumor mass phenotypes. Hepatitis-associated small HCCs that were diagnosed by surveillance demonstrate several phenotypic subsets, with serum GGTP increasing and albumin decreasing in many patients as tumor mass increased. In a patient at risk of HCC, elevated serum GGTP, AFP or ALKP, regardless of bilirubin level, might be a stimulus for appropriate radiology for early HCC diagnosis.