Impact of a shortened surveillance interval on hepatocellular carcinoma survival

3 ISSN 2045-0923 10.2217/HEP.13.1 © 2014 Future Medicine Ltd Hepatic Oncol. (2014) 1(1), 3–5 The surveillance of hepatocellular carcinoma (HCC), which has been a standard of care in the management of patients with chronic liver diseases, greatly contributed to the early detection of liver cancers amenable to curative treatment. Nonetheless, the current strategy for HCC surveillance does not seem to be ideal and the problems may mostly arise from the incompleteness of surveillance tools. As revealed by a study using the cohort of the HALT-C trial, the most common reason for identifying HCC at a late stage was an absence of detection despite adherence to surveillance, which clearly implies that better surveillance tools are required [1]. Ultrasonography (US) is a noninvasive, safe and easy-to-apply method in HCC surveillance, showing a sensitivity of 65–80% [2]. However, the performance characteristics of US becomes poor in obese patients or nodular cirrhotic livers. The role of adding serum a-fetoprotein (AFP) measurement complementary to US is still in debate between eastern and western countries. Unfortunately, a marked progress has not yet been made in terms of development or discovery of novel noninvasive imaging (or a serum biomarker) that could outperform US or AFP. Looking at the recommendation by American Association for the Study of Liver Diseases, the proposed interval of 6–12 months for HCC surveillance is based on the tumor doubling time [3,4]. Although initial studies of small sample size reported that there was no difference in the rate of early HCC detection or survival between 6 and 12 months [5,6], in an Italian study, the median survival of patients with a 6-month interval was significantly longer than those with a 12-month interval, after correction of lead-time bias [7]. Furthermore, in a 15-year prospective Korean study, the corrected 5-year survival of patients, whose surveillance interval was less than 6 months, was significantly higher compared with those with an interval of more than 6 months [8]. Accordingly, the superiority of a 6-month interval compared with a 12-month interval was confirmed both in hepatitis C and B virus-related chronic liver diseases. Based on such recent data, a 6-month interval should be preferred over 12 months in clinical practice. A basic concept regarding HCC surveillance is that determination of interval should be made according to the tumor growth rate, not by the degree of tumor