Ultrasound screening and risk factors for death from hepatocellular carcinoma in a high risk group in Taiwan

Tony Hsiu Hsi Chen, Chien Jen Chen, Ming Fang Yen, Sheng Nan Lu, Chien An Sun, Guan Tarn Huang, Pei Ming Yang, Hsuan Shu Lee, Stephen W. Duffy

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

Although previous studies have demonstrated the ability of ultrasonography (US) screening to detect small asymptomatic hepatocellular carcinoma (HCC), the efficacy of US screening in reducing deaths from HCC still remained unresolved. A 2-stage screening program was designed to identify a high risk group in 7 townships in Taiwan by 6 markers (of risk for HCC) and repeated US screening was further applied to those with at least I positive result for the 6 markers, with a range of 3- to 6-month inter-screening intervals to those with liver cirrhosis or other chronic liver diseases and an annual screening regime for the remaining subjects with normal findings according to US. The 4,843 subjects in this cohort were followed up for an average of 7 years. We compared 4,385 attenders with 458 non-attenders, in conjunction with baseline assessment for self-selection bias. In addition, we assessed baseline variables with respect to their effects on risk of incidence of and mortality from HCC and on risk of incidence of liver cirrhosis. The difference in mortality between attenders and non-attenders was then re-estimated adjusting for significant predictors of cirrhosis, HCC incidence and HCC death as a further guard against baseline differences between attenders and non-attenders in risk profiles. Results of US screening for this high risk group found the mortality was lower by 24% (95% CI: -52 to 62%) in the attenders compared to the non-attenders. After adjustment for sensitivity, the mean sojourn time (MST) were 1.57 (95% CI: 0.94-4.68) for subjects with liver cirrhosis and 2.66 (95% CI: 1.68-6.37) years for non-cirrhotic patient. Significant increases in risk of HCC incidence were associated with increasing age, male gender, hepatitis B surface antigen positive (HbsAg), hepatitis C antibody positive (Anti-HCV), high levels of alanine transaminase (ALT) and alpha-fetoprotein (AFP) and a family history of HCC. Significantly increased risks of liver cirrhosis were associated with predictors of cirrhosis were increasing age, HbsAg, high levels of ALT and of AFP. Significant or borderline significant increases in risk of HCC death were associated with increasing age, male gender, HbsAg, high levels of AST and AFP. Adjusted for the significant variables, the mortality was lower by 41% (95% CI: -20 to 71%, p = 0.1446) in the attenders compared to the non-attenders. The present study provides suggestive evidence on the efficacy of US screening in a selective high risk group in an endemic area of hepatitis B. A randomized controlled trial would yield definitive evidence. Within the protocol of such a trial, a shorter interscreening interval for patients with liver cirrhosis is suggested.

Original languageEnglish
Pages (from-to)257-261
Number of pages5
JournalInternational Journal of Cancer
Volume98
Issue number2
DOIs
Publication statusPublished - Mar 10 2002
Externally publishedYes

Fingerprint

Taiwan
Hepatocellular Carcinoma
Ultrasonography
Liver Cirrhosis
alpha-Fetoproteins
Hepatitis B Surface Antigens
Mortality
Incidence
Alanine Transaminase
Fibrosis
Hepatitis C Antibodies
Selection Bias
Hepatitis B
Liver Diseases
Chronic Disease
Randomized Controlled Trials

Keywords

  • Hepatocellular carcinoma
  • High-risk group
  • Ultrasonography screening

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Ultrasound screening and risk factors for death from hepatocellular carcinoma in a high risk group in Taiwan. / Chen, Tony Hsiu Hsi; Chen, Chien Jen; Yen, Ming Fang; Lu, Sheng Nan; Sun, Chien An; Huang, Guan Tarn; Yang, Pei Ming; Lee, Hsuan Shu; Duffy, Stephen W.

In: International Journal of Cancer, Vol. 98, No. 2, 10.03.2002, p. 257-261.

Research output: Contribution to journalArticle

Chen, Tony Hsiu Hsi ; Chen, Chien Jen ; Yen, Ming Fang ; Lu, Sheng Nan ; Sun, Chien An ; Huang, Guan Tarn ; Yang, Pei Ming ; Lee, Hsuan Shu ; Duffy, Stephen W. / Ultrasound screening and risk factors for death from hepatocellular carcinoma in a high risk group in Taiwan. In: International Journal of Cancer. 2002 ; Vol. 98, No. 2. pp. 257-261.
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