Studies of patients with cirrhosis uncover limitations in liver cancer screening

StephenW

http://www.eurekalert.org/pub_releases/2011-12/w-sop120111.php
Public release date: 1-Dec-2011


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Studies of patients with cirrhosis uncover limitations in liver cancer screening        Two studies available in the December issue of Hepatology, a journal of the American Association for the Study of Liver Diseases, have uncovered limitations in screening for primary liver cancer, also known as hepatocellular carcinoma (HCC). The first study found that, if given the choice during a clinical trial, most patients with cirrhosis prefer surveillance over the possibility of non-screening, therefore making a randomized study of HCC screening not feasible. A second study determined that ultrasonographic screening at three monthly versus six monthly intervals did not improve the detection of small liver cancers.
        Medical evidence reports HCC to be the sixth most common cancer and the third most common cause of cancer death worldwide, with 90% of all cases in western countries attributed to chronic liver diseases, typically at the cirrhosis stage. The National Cancer Institute estimates that more than 26,000 cases and close to 20,000 deaths from liver and bile duct cancer occurred in the U.S. in 2011. Clinical guidelines recommend routine screening for HCC, but the efficacy and optimal intervals for testing are strongly debated by experts.
        In the first study, researchers led by Professor Jacob George from the University of Sydney and Westmead Hospital in Australia, examined the feasibility of undertaking a randomized controlled trial of HCC surveillance in patients with cirrhosis. The screening program included ultrasonography every six months and alpha-fetoprotein testing every three months. Of the 205 participants with cirrhosis who received information outlining the risks and benefits of surveillance for liver cancer, 99.5% declined randomization, with 88% electing for a non-randomized screening program.
        "While a randomized controlled trial is ideal to assess the success of a cancer surveillance program, we found that patients with cirrhosis declined randomization due to possible allocation to a non-screening group," explains Professor George. "Since HCC screening in cirrhotic patients is routine practice for a majority of clinicians, it is impossible to assign patients to a genuine control group. However, further prospective studies that compare individual screening strategies are warranted." In a survey of 40 gastroenterologists of the Sydney Liver Group, the authors found that 74% routinely screen cirrhotic patients despite believing that screening did not increase patient survival (37%) or that the surveillance was cost-effective (66%).
        One such liver cancer screening strategy was investigated by a team of French and Belgian researchers led by Professor Jean-Claude Trinchet with the Hôpital Jean Verdier in Bondy, France. The team conducted a multicentre trial with 1278 cirrhotic patients who received ultrasonographic screening at either three-month or six-month intervals. Their results indicated that cirrhosis resulted from excessive alcohol use in 39% of participants, 44% from hepatitis C virus (HCV), and 13% from hepatitis B virus (HBV). During the study period from July 2000 to July 2009, researchers detected at least one focal lesion in 28% of patients, but confirmed small HCC (less than 30 mm) in only 10% of participants.
        Dr. Trinchet said, "Our study found that ultrasonographic surveillance performed every three months detects more small focal lesions than screening at six-month intervals. However, more frequent screening did not improve the detection of liver cancer at an earlier stage." The authors note that detection of small tumors were more likely missed in patients with HCV or who abuse alcohol and suggest the limitations of current diagnostic procedures may explain their negative findings. Again, further investigations of screening methods and diagnostic procedures are needed to improve the outcomes in those at risk for developing liver cancer.
       

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        Full Citations: "Feasibility of Conducting a Randomized Control Trial for Liver Cancer Screening: Is a Randomized Controlled Trial for Liver Cancer Screening Feasible or Still Needed?" H. Poustchi, GC Farrell, SI Strasser, AU Lee, GW McCaughan and J George.Hepatology; August 24, 2011 (DOI: 10.1002/hep.24581); Print Issue Date: December 2011. http://onlinelibrary.wiley.com/doi/10.1002/hep.24581/abstract.
        "Ultrasonographic Surveillance of Hepatocellular Carcinoma in Cirrhosis: A Randomized Trial Comparing 3- and 6-month Periodicities." Jean-Claude Trinchet, Cendrine Chaffaut, Valérie Bourcier, Françoise Degos, Jean Henrion, Hélène Fontaine, Dominique Roulot, Ariane Mallat, Sophie Hillaire, Paul Cales, Isabelle Ollivier, Jean-Pierre Vinel, Philippe Mathurin, Jean-Pierre Bronowicki, Valérie Vilgrain, Gisèle N'kontchou, Michel Beaugrand and Sylvie Chevret. Hepatology; September 6, 2011 (DOI: 10.1002/hep.24545); Print Issue Date: December 2011. http://onlinelibrary.wiley.com/doi/10.1002/hep.24545/abstract.
        Author Contact: To arrange an interview with Professor George, please contact Ellie Martel with the University of Sydney at [email protected].
        These studies are published in Hepatology. Media wishing to receive a PDF of the articles may contact [email protected].
        About the Journal
Hepatology is the premier publication in the field of liver disease, publishing original, peer-reviewed articles concerning all aspects of liver structure, function and disease. Hepatology's current impact factor is 10.885.Each month, the distinguished Editorial Board monitors and selects only the best articles on subjects such as immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases and their complications, liver cancer, and drug metabolism. Hepatology is published on behalf of the American Association for the Study of Liver Diseases (AASLD). For more information, please visit http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1527-3350 .
        About Wiley-Blackwell
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StephenW

公开发布日期：2011年12月1日


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肝硬化患者的研究发现，在肝癌筛查两项研究在12月，美国肝病研究协会杂志肝脏问题，已经发现在筛选又称肝癌，原发性肝癌的局限性限制（肝癌）。第一项研究发现，如果在一项临床试验的选择，肝硬化患者最喜欢监视在非筛选的可能性，因此使的肝癌筛查的随机研究并不可行。第二项研究决定，在每月对6个月的时间间隔三个超声筛查没有提高小肝癌的检测。
        医学证据报告肝癌是第六个最常见的癌症，全球癌症死亡的第三大最常见的原因，在西方国家的所有案件的90％归因于慢性肝脏疾病，通常在肝硬化阶段，。国家癌症研究所估计，在2011年发生在美国超过26000例，接近20000从肝脏和胆管细胞癌死亡。肝癌的临床指引建议例行检查，但进行测试的有效性和最佳的时间间隔由专家的强烈辩论。
        雅各布乔治教授带领，在澳大利亚悉尼Westmead医院大学的研究人员，在第一项研究中，研究肝硬化患者HCC的监测进行的随机对照试验的可行性。检查的项目包括超声检查，每半年和甲胎蛋白检测每三个月。肝硬化205与会者收到的信息概述监察肝癌的风险和利益，99.5％下降随机，88％为一个非随机筛选程序选出。
        乔治，“教授解释：”虽然随机对照试验，以评估癌症监测计划的成功，是理想的，我们发现，肝硬化患者由于可能分配到非筛查组下降随机。 “由于肝硬化患者的肝癌筛查，为广大临床医师的常规做法，这是不可能分配到一个真正的对照组患者，但进一步的前瞻性研究，比较个别的筛选策略是必要的。”在悉尼肝组的40肠胃进行的调查，笔者发现，74％的常规屏幕尽管认为筛选肝硬化患者没有增加患者的生存率（37％）或监视成本效益（66％）。
        一个这样的肝癌筛查的策略是由法国和比利时的研究人员与医院的Jean维迪尔在邦迪，法国让 - 克洛德教授Trinchet领导的团队。该小组进行超声筛查在任3个月或6个月的时间间隔与1278肝硬化患者的多中心试验。他们的研究结果表明，肝硬化，过量饮酒导致参与者的39％，44％的丙型肝炎病毒（HCV），B型肝炎病毒（HBV）和13％。在研究期间从2000年7月至2009年7月，研究人员发现在28％的患者至少有一个病灶，小肝癌（小于30毫米），但只有10％的参与者证实。
        Trinchet博士说，“我们的研究发现，超声监视执行每三个月检测筛选比在6个月的时间间隔更小的局灶性病变，但更频繁的检查没有好转的肝癌在早期阶段检测。”作者指出，小肿瘤检测，更有可能错过了与丙型肝炎病毒或酗酒的人患者，并建议目前的诊断程序的限制，可能解释他们的负面结果。同样，筛查方法和诊断程序需要进一步调查的成果，以改善发展肝癌的风险。
      

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        全部参考文献：“开展肝癌筛查的随机对照试验的可行性：可行的或仍需要为肝癌筛查是一项随机对照试验？” H. Poustchi，气相色谱法雷尔，SI斯特拉瑟，李盟，毛重McCaughan和J George.Hepatology; 8月24日，2011（作者：10.1002/hep.24581）;打印发行日期：2011年12月。 http://onlinelibrary.wiley.com/doi/10.1002/hep.24581/abstract。
        “肝硬化，肝癌癌的超声监测：一项随机试验，比较3 - 6个月的周期性。”吉恩克劳德Tr​​inchet，Cendrine Chaffaut，瓦莱丽Bourcier，弗朗索瓦Degos，让Henrion，伊莲娜丹，Roulot多米尼克，阿丽亚娜Mallat的，Hillaire梁刘柔芬，保罗Cales，伊莎贝尔奥利维耶，让 - 皮埃尔Vinel，菲利普马图林，让 - 皮埃尔Bronowicki，瓦莱丽Vilgrain吉赛尔邦N'kontchou，米歇尔Beaugrand和西尔维Chevret。肝病; 2011年9月6日（作者：10.1002/hep.24545）;打印发行日期：2011年12月。 http://onlinelibrary.wiley.com/doi/10.1002/hep.24545/abstract。
        作者联系方式：要安排与教授乔治的采访，请联系艾莉马特尔ellie.martel @ sydney.edu.au悉尼大学。
        这些研究结果发表在肝脏。媒体希望收到一份PDF格式的文章可能接触[email protected]。