Document Detail


Detection of hepatocellular carcinoma at advanced stages among patients in the HALT-C trial: where did surveillance fail?
MedLine Citation:
PMID:  23337478     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Only 40% of patients with hepatocellular carcinoma (HCC) are diagnosed at an early stage, suggesting breakdowns in the surveillance process. The aim of our study was to assess the reasons behind surveillance process failures among patients in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial (HALT-C), which prospectively collected HCC surveillance data on a large cohort of patients.
METHODS: Binary regression analysis was used to identify predictors of consistent surveillance, which was defined as having an ultrasound and alpha-fetoprotein every 12 months. Surveillance failures among patients who developed HCC were classified into one of three categories: absence of screening, absence of follow-up, or absence of detection.
RESULTS: Over a mean follow-up of 6.1 years, 692 (68.9%) of 1,005 patients had consistent surveillance. Study site was the strongest predictor of consistent surveillance (P<0.001). After adjusting for study site, patient-level predictors of consistent surveillance included platelet count >150,000/mm(3) (hazard ratio (HR) 1.28; 95% confidence interval (CI): 1.05-1.56) and complete clinic visit adherence (HR 1.72, 95% CI: 1.11-2.63). Of 83 patients with HCC, 23 (27.7%) were detected beyond Milan criteria. Three (13%) had late-stage HCC due to the absence of screening, 4 (17%) due to the absence of follow-up, and 16 (70%) due to the absence of detection.
CONCLUSIONS: Surveillance process failures, including absence of screening or follow-up, are common and potentially contribute to late-stage tumors in one-third of cases. However, the most common reason for finding HCC at a late stage was an absence of detection, suggesting better surveillance strategies are needed.
Authors:
Amit G Singal; Mahendra Nehra; Beverley Adams-Huet; Adam C Yopp; Jasmin A Tiro; Jorge A Marrero; Anna S Lok; William M Lee
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-22
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  108     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-05     Completed Date:  2013-05-20     Revised Date:  2013-07-23    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  425-32     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, UT Southwestern Medical Center, and Parkland Health and Hospital System, Dallas, Texas 75390-8887, USA. amit.singal@utsouthwestern.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Antiviral Agents / therapeutic use
Carcinoma, Hepatocellular / blood,  diagnosis*,  etiology
Early Detection of Cancer
Female
Hepatitis C, Chronic / drug therapy,  pathology
Humans
Interferon-alpha / therapeutic use
Liver Cirrhosis / blood,  complications*,  pathology
Liver Neoplasms / blood,  diagnosis*,  etiology
Male
Middle Aged
Polyethylene Glycols / therapeutic use
Recombinant Proteins / therapeutic use
Risk Factors
alpha-Fetoproteins / metabolism
Grant Support
ID/Acronym/Agency:
KL2 TR000453/TR/NCATS NIH HHS; UL1-TR000451/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Antiviral Agents; 0/Interferon-alpha; 0/Polyethylene Glycols; 0/Recombinant Proteins; 0/alpha-Fetoproteins; 0/peginterferon alfa-2a
Comments/Corrections
Comment In:
Am J Gastroenterol. 2013 Jun;108(6):1014   [PMID:  23735925 ]
Am J Gastroenterol. 2013 Jun;108(6):1013-4   [PMID:  23735924 ]

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