Application of surveillance programs for hepatocellular carcinoma in the Asia-Pacific Region

Deepak Amarapurkar, KwangHyub Han, Henry Lik Yuen Chan, Yoshiyuki Ueno

Research output: Contribution to journalReview article

47 Citations (Scopus)

Abstract

Hepatocellular carcinoma (HCC) is a potential target for cancer surveillance (or screening) as it occurs in well-defined, at-risk populations and curative therapy is possible only for small tumors. Surveillance has been recommended by regional liver societies and is practiced widely, but its benefits are not clearly established. Hepatic ultrasonography with or without alpha fetoprotein (AFP) performed every 6 months is the preferred program. Surveillance of HCC has been well shown to detect small tumors for curative treatment, which may be translated to improved patient survival. However, most studies are limited by lead-time bias, length bias for early diagnosis of small HCC, different tumor growth rates and poor compliance with surveillance. Cost-effectiveness of surveillance programs depends on the rate of small HCC detected 'accidentally' (routine imaging) in a comparator group, annual incidence of HCC with various etiologies, patient age and the availability of liver transplantation. The incremental cost-effectiveness for 6-monthly AFP and ultrasound has been estimated from approximately $US26 000-74 000/quality adjusted life years (QALY). All cirrhotic patients are therefore recommended for HCC surveillance unless the disease is too advanced for any curative treatment. As chronic hepatitis B can develop into HCC without going through liver cirrhosis, high-risk non-cirrhotic chronic hepatitis B patients are also recommended for HCC surveillance. In conclusion, HCC surveillance could be effective at reducing disease-specific mortality with acceptable cost-effectiveness among selected patient groups, provided it is a well-organized program.

Original languageEnglish
Pages (from-to)955-961
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume24
Issue number6
DOIs
Publication statusPublished - 2009 Jan 1

Fingerprint

Hepatocellular Carcinoma
Cost-Benefit Analysis
Chronic Hepatitis B
alpha-Fetoproteins
Neoplasms
Quality-Adjusted Life Years
Liver
Liver Cirrhosis
Liver Transplantation
Early Diagnosis
Ultrasonography
Therapeutics
Survival
Mortality
Incidence
Growth

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

@article{7326b08007e543088141c1bbe190be1b,
title = "Application of surveillance programs for hepatocellular carcinoma in the Asia-Pacific Region",
abstract = "Hepatocellular carcinoma (HCC) is a potential target for cancer surveillance (or screening) as it occurs in well-defined, at-risk populations and curative therapy is possible only for small tumors. Surveillance has been recommended by regional liver societies and is practiced widely, but its benefits are not clearly established. Hepatic ultrasonography with or without alpha fetoprotein (AFP) performed every 6 months is the preferred program. Surveillance of HCC has been well shown to detect small tumors for curative treatment, which may be translated to improved patient survival. However, most studies are limited by lead-time bias, length bias for early diagnosis of small HCC, different tumor growth rates and poor compliance with surveillance. Cost-effectiveness of surveillance programs depends on the rate of small HCC detected 'accidentally' (routine imaging) in a comparator group, annual incidence of HCC with various etiologies, patient age and the availability of liver transplantation. The incremental cost-effectiveness for 6-monthly AFP and ultrasound has been estimated from approximately $US26 000-74 000/quality adjusted life years (QALY). All cirrhotic patients are therefore recommended for HCC surveillance unless the disease is too advanced for any curative treatment. As chronic hepatitis B can develop into HCC without going through liver cirrhosis, high-risk non-cirrhotic chronic hepatitis B patients are also recommended for HCC surveillance. In conclusion, HCC surveillance could be effective at reducing disease-specific mortality with acceptable cost-effectiveness among selected patient groups, provided it is a well-organized program.",
author = "Deepak Amarapurkar and KwangHyub Han and Chan, {Henry Lik Yuen} and Yoshiyuki Ueno",
year = "2009",
month = "1",
day = "1",
doi = "10.1111/j.1440-1746.2009.05805.x",
language = "English",
volume = "24",
pages = "955--961",
journal = "Journal of Gastroenterology and Hepatology (Australia)",
issn = "0815-9319",
publisher = "Wiley-Blackwell",
number = "6",

}

Application of surveillance programs for hepatocellular carcinoma in the Asia-Pacific Region. / Amarapurkar, Deepak; Han, KwangHyub; Chan, Henry Lik Yuen; Ueno, Yoshiyuki.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 24, No. 6, 01.01.2009, p. 955-961.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Application of surveillance programs for hepatocellular carcinoma in the Asia-Pacific Region

AU - Amarapurkar, Deepak

AU - Han, KwangHyub

AU - Chan, Henry Lik Yuen

AU - Ueno, Yoshiyuki

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Hepatocellular carcinoma (HCC) is a potential target for cancer surveillance (or screening) as it occurs in well-defined, at-risk populations and curative therapy is possible only for small tumors. Surveillance has been recommended by regional liver societies and is practiced widely, but its benefits are not clearly established. Hepatic ultrasonography with or without alpha fetoprotein (AFP) performed every 6 months is the preferred program. Surveillance of HCC has been well shown to detect small tumors for curative treatment, which may be translated to improved patient survival. However, most studies are limited by lead-time bias, length bias for early diagnosis of small HCC, different tumor growth rates and poor compliance with surveillance. Cost-effectiveness of surveillance programs depends on the rate of small HCC detected 'accidentally' (routine imaging) in a comparator group, annual incidence of HCC with various etiologies, patient age and the availability of liver transplantation. The incremental cost-effectiveness for 6-monthly AFP and ultrasound has been estimated from approximately $US26 000-74 000/quality adjusted life years (QALY). All cirrhotic patients are therefore recommended for HCC surveillance unless the disease is too advanced for any curative treatment. As chronic hepatitis B can develop into HCC without going through liver cirrhosis, high-risk non-cirrhotic chronic hepatitis B patients are also recommended for HCC surveillance. In conclusion, HCC surveillance could be effective at reducing disease-specific mortality with acceptable cost-effectiveness among selected patient groups, provided it is a well-organized program.

AB - Hepatocellular carcinoma (HCC) is a potential target for cancer surveillance (or screening) as it occurs in well-defined, at-risk populations and curative therapy is possible only for small tumors. Surveillance has been recommended by regional liver societies and is practiced widely, but its benefits are not clearly established. Hepatic ultrasonography with or without alpha fetoprotein (AFP) performed every 6 months is the preferred program. Surveillance of HCC has been well shown to detect small tumors for curative treatment, which may be translated to improved patient survival. However, most studies are limited by lead-time bias, length bias for early diagnosis of small HCC, different tumor growth rates and poor compliance with surveillance. Cost-effectiveness of surveillance programs depends on the rate of small HCC detected 'accidentally' (routine imaging) in a comparator group, annual incidence of HCC with various etiologies, patient age and the availability of liver transplantation. The incremental cost-effectiveness for 6-monthly AFP and ultrasound has been estimated from approximately $US26 000-74 000/quality adjusted life years (QALY). All cirrhotic patients are therefore recommended for HCC surveillance unless the disease is too advanced for any curative treatment. As chronic hepatitis B can develop into HCC without going through liver cirrhosis, high-risk non-cirrhotic chronic hepatitis B patients are also recommended for HCC surveillance. In conclusion, HCC surveillance could be effective at reducing disease-specific mortality with acceptable cost-effectiveness among selected patient groups, provided it is a well-organized program.

UR - http://www.scopus.com/inward/record.url?scp=66549114663&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66549114663&partnerID=8YFLogxK

U2 - 10.1111/j.1440-1746.2009.05805.x

DO - 10.1111/j.1440-1746.2009.05805.x

M3 - Review article

C2 - 19383082

AN - SCOPUS:66549114663

VL - 24

SP - 955

EP - 961

JO - Journal of Gastroenterology and Hepatology (Australia)

JF - Journal of Gastroenterology and Hepatology (Australia)

SN - 0815-9319

IS - 6

ER -