• Richard Todd Stravitz, Douglas M Heuman, Nisha Chand, Richard K Sterling, Mitchell L Shiffman, Velimir A Luketic, Arun J Sanyal, Adil Habib, Anastasios A Mihas, Ho-Chong S Giles, Daniel G Maluf, Adrian H Cotterell, Marc P Posner, and Robert A Fisher.
• Section of Hepatology, Hume-Lee Transplant Center of Virginia Commonwealth University, Richmond, VA 23298-0341, USA. rstravit@hsc.vcu.edu
• Am. J. Med. 2008 Feb 1; 121 (2): 119-26.

ObjectiveLiver transplantation has become an effective treatment for cirrhotic patients with early-stage hepatocellular carcinoma. We hypothesized that the quality of surveillance for hepatocellular carcinoma influences prognosis by affecting access to liver transplantation.MethodsA total of 269 patients with cirrhosis and hepatocellular carcinoma were retrospectively categorized into 3 groups according to quality of surveillance: standard-of-care (n=172) (group 1); substandard surveillance (n=48) (group 2); and absence of surveillance in patients not recognized to be cirrhotic (n=59) (group 3).ResultsThree-year survival in the 60 patients who underwent liver transplantation was 81% versus 12% for patients who did not undergo transplantation (P<.001). The percentages of patients who underwent transplantation according to tumor stage at diagnosis (T1, T2, T3, and T4) were 58%, 35%, 10%, and 1%, respectively. Hepatocellular carcinoma was diagnosed at stages 1 and 2 in 70% of patients in group 1, 37% of patients in group 2, and only 18% of patients in group 3 (P <.001). Liver transplantation was performed in 32% of patients in group 1, 13% of patients in group 2, and 7% of patients in group 3 (P<.001). Three-year survival from cancer diagnosis in patients in group 3 (12%) was significantly worse than in patients in group 1 (39%) or group 2 (27%) (each P<.05). Eighty percent of patients in group 3 had subtle abnormalities of cirrhosis on routine laboratory tests.ConclusionThe quality of surveillance has a direct impact on hepatocellular carcinoma stage at diagnosis, access to liver transplantation, and survival.

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