Skip to main content

Advertisement

Log in

Randomized controlled trial of screening for hepatocellular carcinoma

  • Original Paper
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Screening for hepatocellular carcinoma (HCC) has been conducted for over 20 years, but there is no conclusive evidence that screening may reduce HCC mortality. The aim of this study was to assess the effect of screening on HCC mortality in people at increased risk.

Methods

This study included 18,816 people, aged 35–59 years with hepatitis B virus infection or a history of chronic hepatitis in urban Shanghai, China. Participants were randomly allocated to a screening (9,373) or control (9,443) group. Controls received no screening and continued to use health-care facilities. Screening group participants were invited to have an AFP test and ultrasonography examination every 6 months. Screening was stopped in December 1997; by that time screening group participants had been offered five to ten times. All participants were followed up until December 1998. The primary outcome measure was HCC mortality.

Results

The screened group completed 58.2 percent of the screening offered. When the screening group was compared to the control group, the number of HCC was 86 versus 67; subclinical HCC being 52 (60.5%) versus 0; small HCC 39 (45.3%) versus 0; resection achieved 40 (46.5%) versus 5 (7.5%); 1-, 3,-, and 5-year survival rate 65.9%, 52.6%, 46.4% versus 31.2%, 7.2%, 0, respectively. Thirty-two people died from HCC in the screened group versus 54 in the control group, and the HCC mortality rate was significantly lower in the screened group than in controls, being 83.2/100,000 and 131.5/100,000, respectively, with a mortality rate ratio of 0.63 (95%CI 0.41–0.98).

Conclusions

Our finding indicated that biannual screening reduced HCC mortality by 37%.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  • Chen DS, Sheu JC, Sung JL, Lai MY, Lee CS, Su CT (1982) Small hepatocellular carcinoma: a clinicopathological study in thirteen patients. Gastroenterology 83:1109–1119

    CAS  PubMed  Google Scholar 

  • Chen JG, Lu JH, Zhang BC, Chen QG, Hui ZX, Shen QJ (1997) Study on effect of screening on mortality of primary cancer of liver. Chin J Public Health 16:341–343

    Google Scholar 

  • Izzo F, Cremona F, Ruffolo F, Palaia R, Parisi V, Curley SA (1998) Outcome of 67 patients with hepatocellular cancer detected during screening of 1125 patients with chronic hepatitis. Ann Surg 227:513–518

    Article  CAS  PubMed  Google Scholar 

  • McMahon BJ, London T (1991) Workshop on screening for hepatocellular carcinoma. J Natl Cancer Inst 83:916–919

    CAS  PubMed  Google Scholar 

  • McMahon BJ, Bulkow L, Harpster A, Snowball M, Lanier A, Sacco F, Dunaway E, Williams J (2000) Screening for hepatocellular carcinoma in Alaska natives infected with chronic hepatitis B: a 16-year population-based study. Hepatology 32:842–846

    Article  CAS  PubMed  Google Scholar 

  • Mima S, Sekiya C, Kanagawa H, Kohyama H, Gotoh K, Mizuo H (1994) Mass screening for hepatocellular carcinoma: experience in Hokkaido, Japan. J Gastroenterol Hepatol 9:361–365

    CAS  PubMed  Google Scholar 

  • Parkin DM, Bray F, Ferlay J, Pisani P (2001) Estimating the world cancer burden: Globocan 2000. Int J Cancer 94:153–156

    Google Scholar 

  • Purves LR (1976) Alpha-fetoprotein and the diagnosis of liver cell cancer. In: Cameron HM, Linsell DA, Warwick GP (eds) Liver cell cancer. Elsevier, Amsterdam, The Netherlands, pp 61–80

  • Shanghai Coordinating Group for Research on Liver Cancer (1979) Diagnosis and treatment of primary hepatocellular carcinoma in early stage—report of 134 cases. Chin J Med 92:801–806

    Google Scholar 

  • Sherman M, Pelterkiam KM, Lee C (1995) Screening for hepatocellular carcinoma in chronic carriers of hepatitis B virus: incidence and prevalence of hepatocellular carcinoma in a North American urban population. Hepatology 22:432–438

    CAS  PubMed  Google Scholar 

  • Tang ZY, Yang BH, Tang CL (1980) Evaluation of population screening for hepatocellular carcinoma. Chin Med J 93:795–799

    CAS  PubMed  Google Scholar 

  • Tang ZY (1989) Efforts in the past decades to improve the ultimate outcome of primary liver cancer. In: Tang ZY, Wu MC, Xia SS (eds) Primary liver cancer. Springer, Berlin Heidelberg New York, pp 469–481

  • Tatarinov Y (1964) Detection of embryo-specific-globulin in the blood sera of patients with primary liver tumors. Vopr Med Khim 10:90–91

    CAS  PubMed  Google Scholar 

  • The Liver Cancer Study Group of Japan (1990) Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg 211:277–287

    PubMed  Google Scholar 

  • Yang B, Zhang B, Yu Y, Wang W, Shen Y, Zhang A, Xiang Y, Xu Z (1997) Prospective study of early detection for primary liver cancer. J Cancer Res Clin Oncol 123:357–360

    Article  CAS  PubMed  Google Scholar 

  • Yang BH, Tang ZY (1988) HCC detected in mass screening from high risk population. Chin J Digest 8:130–133

    Google Scholar 

  • Yang BH, Tang ZY (1989) The value of real-time ultrasonography in massive screening for primary liver cancer. Tumor 9:117–118

    Google Scholar 

  • Yang BH, Liu KD, Tang ZY (1987) Mass survey for hepatocellular carcinoma in high risk population. Tumor 7:82–83

    Google Scholar 

  • Yu SZ (1995) Primary prevention of hepatocellular carcinoma. J Gastroenterol Hepatol 10:674–682

    CAS  PubMed  Google Scholar 

  • Zhang B, Yang B (1999) Combined alpha-fetoprotein testing and ultrasonography as a screening test for primary liver cancer. J Med Screen 6:108–110

    CAS  PubMed  Google Scholar 

  • Zhang BC, Wang MR, Chen JG, Jiang RH, Chen QG, Hui ZG (1994) Analysis of patients with primary liver cancer detected (1) at mass screening and (2) during follow-up period in a high risk population. Chin J Clin Oncol 21:489–491

    Google Scholar 

  • Zhang B, Yang B, Yu Z (1995) The study of high-risk population for primary liver cancer. Tumor 15:80–82

    Google Scholar 

  • Zhu YR, Lu XB (1983) Clinical implication of AFP serosurvey. Chin J Oncol 5:38–40

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bo-Heng Zhang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zhang, BH., Yang, BH. & Tang, ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 130, 417–422 (2004). https://doi.org/10.1007/s00432-004-0552-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-004-0552-0

Keywords

Navigation