Surveillance for Hepatocellular Carcinoma in Patients With Cirrhosis

Chapter 2: Diagnosis and surveillance

International Liver Cancer Association (ILCA) White Paper on Biomarker Development for Hepatocellular Carcinoma

Management of patients with hepatitis B virus-induced cirrhosis

DETECT: Development of Technologies for Early HCC Detection

EUS-guided FNA could be another important tool for the early diagnosis of hepatocellular carcinoma

Most cases of hepatocellular carcinoma (HCC) are associated with cirrhosis related to chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. Changes in the time trends of HCC and most variations in its age-, sex-, and race-specific rates among different regions are likely to be related to differences in hepatitis viruses that are most prevalent in a population, the timing of their spread, and the ages of the individuals the viruses infect. Environmental, host genetic, and viral factors can affect the risk of HCC in individuals with HBV or HCV infection. This review summarizes the risk factors for HCC among HBV- or HCV-infected individuals, based on findings from epidemiologic studies and meta-analyses, as well as determinants of patient outcome and the HCC disease burden, globally and in the United States.

Development of Serum DHCR24 Antibody as a Marker for Hepatocellular Carcinoma: The End of the Beginning

Background Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third cause of cancer-related mortality world- wide. The incidence of HCC is on the increase, and it is a major threat to our modern life. Epidemiological studies have indicated that HCC are related to chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infection. Aim of the Work To evaluate the role of AFU as a diagnostic marker versus AFP in HCC post viral cirrhotic Egyptian patients. Patients and Methods This study had been carried out on 90 subjects, age range 21-75 year selected from Internal medicine and Hepatology outpatient clinics and inpatient wards at Ain shams university hospitals from January 2022 to June 2022. Results We found that serum levels of AFU were highest in patients of group A with HCC (129.867 ± 32.997 μl U/ml) compared to those with liver cirrhosis (33.433± 14.818 μl U/ml) with P value < 0.001 and the control groups (3.177 ± 1.199 μl U/ml) with P value < 0.001. Similarly alpha fetoprotein its serum levels were much higher in the HCC group (4688.223±11490.009 ng/ml) compared to the cirrhotic patients (4.407±3.107 ng/ml) with P value 0.02 Also, compared to healthy individuals (2.623±1.566 ng/ml) with p value 1.00. We found that there is No significant statistical correlation between serum AFP and AFU in our studied HCC and cirrhotic patients (R 0.332, P 0.073 for HCC and R 0.222, P 0.238 for cirrhotic). Regarding the negative correlation between serum AFU level and AFP level in order to predict the diagnostic value, sensitivity and specificity of both of them in term of tumor size, our study show that for AFU when the best cut off value was >52μl U/ml the sensitivity was 100% and specificity was 90% while for AFP when the best cut off value was > 10.5 ng/ml the sensitivity was 96.67% and specificity 96.67%. AFU is a promising serum tumor marker for HCC diagnosis and can be combined with AFP. Conclusion We concluded from this study that: Serum AFP was highly significant increase in HCC patients compared to cirrhotic and healthy controls, this is in agreement with many several reports that consider AFP in high serum levels as diagnostic for HCC combined with triphasic CT abdomen or dynamic MRI. Serum AFU levels were significantly higher in patients with HCC and mildly elevated in patients with liver cirrhosis compared to the control group. So it can be used as a tumor marker for HCC diagnosis. No correlation between AFU and laboratory data and child score. AFU was not influenced by clinical condition of the liver itself but with HCC. Around 40% of HCC patients have normal or low AFP level so AFU may be useful as a diagnostic marker in those patients. Serum AFP is the standard tumor marker used in clinical practice for diagnosis and surveillance of HCC in cirrhotic patients in spite of normal and low AFP HCC patients that may reach 40%. Sensitivity and specificity of AFU was nearly similar to sensitivity and specificity of AFP. Combined use of AFU with AFP or possibly other markers will improve the diagnostic field and can help in early detection of HCC in surveillance programms.

Screening for hepatocellular carcinoma: Good enough but best yet to come

Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality and healthcare expenditure in patients with chronic liver disease. There are no consensus guidelines on diagnosis and management of HCC in India. The Indian National Association for Study of the Liver (INASL) set up a Task-Force on HCC in 2011, with a mandate to develop consensus guidelines for diagnosis and management of HCC, relevant to disease patterns and clinical practices in India. The Task-Force first identified various contentious issues on various aspects of HCC and these issues were allotted to individual members of the Task-Force who reviewed them in detail. The Task-Force used the Oxford Center for Evidence Based Medicine-Levels of Evidence of 2009 for developing an evidence-based approach. A 2-day round table discussion was held on 9th and 10th February, 2013 at Puri, Odisha, to discuss, debate, and finalize the consensus statements. The members of the Task-Force reviewed and discussed the existing literature at this meeting and formulated the INASL consensus statements for each of the issues. We present here the INASL consensus guidelines (The Puri Recommendations) on prevention, diagnosis and management of HCC in India.

Impact of Surveillance on Survival of Patients With Initial Hepatocellular Carcinoma: A Study From Japan

Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go?

Reducing the incidence of hepatocellular carcinoma (HCC) in HIV-infected patients has become a serious problem when managing these patients. There are many explanations for this disease evolution, which notably include their longer survival under effective antiviral therapy and also the more rapid evolution of chronic liver disease. Despite recent advances in the management of hepatitis B (HBV) and hepatitis C (HCV) viral diseases, which will probably increase the number of patients achieving a virological response, HIV-infected patients with cirrhosis are still at risk of the onset of HCC. This evolution to HCC is also correlated to other comorbidities such as excessive alcohol consumption and nonalcoholic steatohepatitis (NASH). HCC thus remains a public health issue in this population. The poor prognosis and aggressiveness of HCC have been fully demonstrated, but the mechanisms underlying this aggressiveness are not yet well defined. As well as underlying mechanisms that contribute to accelerating hepatocarcinogenesis in HIV-infected patients, there are other reasons why HIV-infected patients should be considered a higher risk population. This review discusses the principal epidemiological determinants; the mechanisms of pathogenesis; and the treatment of HCC in HIV/HBV and HIV/HCV coinfected patients. It also discusses the probable need to develop a specific screening policy for HCC in this population in order to prevent the rapid development and to make them more amenable to a curative treatment.

α-Fetoprotein for Hepatocellular Carcinoma Diagnosis: The Demise of a Brilliant Star

Liver cancer is the second leading cause of cancer death worldwide, responsible for an estimated 746,000 deaths and 782,000 new cases in 2012 [1]. The countries in the Western Pacific region accounts for 64% and China alone accounts for 51% of the new liver cancer cases and deaths each year. Approximately 80% of hepatocellular carcinoma (HCC), the most common type of liver cancer, is associated with viral hepatitis [1]. In countries with high prevalence of hepatitis B virus (HBV) infection, such as China, up to 80% of HCC is associated with hepatitis B [2]. Liver cancer carries a poor prognosis with a global mortality to incidence ratio of 0.95 [1]. In the USA, the 1-year survival rate remains less than 50% [3]. Asians and Pacific Islanders have the highest incidence of HCC among the different racial/ethnic groups. While every individual with chronic hepatitis B infection (CHB) or HBV carrier is at risk for developing HCC, disease progression leading to cirrhosis is associated with the greatest risk [2]. In an effort to improve survival through early detection of HCC, the American Association for the Study of Liver Diseases recommended HCC screening with abdominal ultrasound (US) at 6–12 month intervals of HBV carriers considered at increased risk for HCC, including those with cirrhosis, family history of liver cancer and Asian male HBV carriers above the age of 40 [4,5]. However, it remains controversial whether population-wide HCC screening of CHB patients results in a reduction in HCC mortality particularly in resource-constraint regions of the world that have the highest burden of HCC. The only two randomized trials available to date are both from China [6,7]. A population-based study in the city of Shanghai, conducted by the Liver Cancer Institute of Fudan University, reported 1-year HCC survival rates improved from 31.2% in the control group to 65.9% in the screened group among 18,816 CHB patients aged 35–59 years with or without cirrhosis, who were randomized into either a group using US and AFP screening every 6 months or a control group [6]. The second study from a rural setting in Qidong, using AFP screening every 6 months without US, did not show any improvement in survival [7]. According to the National Cancer Institute [8], screening for HCC