Hepatocellular Carcinoma Surveillance at 4-vs. 12-Month Intervals for Patients With Chronic Viral Hepatitis : A Randomized Study in Community

OBJECTIVES: To compare the efficacy of hepatocellular carcinoma (HCC) surveillance at 4- and 12-month intervals in a community for patients with chronic viral hepatitis and thrombocytopenia. METHODS: In 10 townships, adults (>= 40 years) with platelet <= 150 (x 10(9))/l, positive hepatitis B surface antigen, or antibody to hepatitis C virus were invited to this study. These townships were randomized into 4-(group A) and 12-month (group B) interval surveillance groups. Seven hundred and eighty-five and 796 residents met the study criteria in groups A and B. Ultrasonography (US) was the surveillance method. RESULTS: A total of 744 residents (group A: 387; group B: 357) were enrolled. In the study period, HCC was diagnosed in 39 residents (group A: 24; group B: 15). There was no difference in cumulative 3-year HCC incidence between the two groups. The tumors were smaller in group A than in group B, though group A had more patients with tumor <= 2 cm (P=0.003) who were in Barcelona Clinic Liver Cancer (BCLC) very-early stage (P=0.017) and had undergone curative treatments (P=0.049). Male gender, cirrhosis, and platelet <= 100 (x 10 9)/l were associated factors of HCC occurrence. There was no difference in 4-year overall survival between the two groups. Patients undergoing recommended treatments had better 4-year survival rates. CONCLUSIONS: Compared with 12-month interval, US surveillance at 4-month interval detected more patients with HCC <= 2 cm who were in BCLC very-early stage and were fit for curative treatments. Up to 4-year follow-up, however, the overall survival was not different. Am J Gastroenterol 2013;108:416-424; doi:10.1038/ajg.2012.445; published online 15 January 2013