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.
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.
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).
Our finding indicated that biannual screening reduced HCC mortality by 37%.
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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
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
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
McMahon BJ, London T (1991) Workshop on screening for hepatocellular carcinoma. J Natl Cancer Inst 83:916–919
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
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
Parkin DM, Bray F, Ferlay J, Pisani P (2001) Estimating the world cancer burden: Globocan 2000. Int J Cancer 94:153–156
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
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
Tang ZY, Yang BH, Tang CL (1980) Evaluation of population screening for hepatocellular carcinoma. Chin Med J 93:795–799
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
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
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
Yang BH, Tang ZY (1988) HCC detected in mass screening from high risk population. Chin J Digest 8:130–133
Yang BH, Tang ZY (1989) The value of real-time ultrasonography in massive screening for primary liver cancer. Tumor 9:117–118
Yang BH, Liu KD, Tang ZY (1987) Mass survey for hepatocellular carcinoma in high risk population. Tumor 7:82–83
Yu SZ (1995) Primary prevention of hepatocellular carcinoma. J Gastroenterol Hepatol 10:674–682
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
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
Zhang B, Yang B, Yu Z (1995) The study of high-risk population for primary liver cancer. Tumor 15:80–82
Zhu YR, Lu XB (1983) Clinical implication of AFP serosurvey. Chin J Oncol 5:38–40
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Zhang, B., Yang, B. & Tang, Z. 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
- Hepatocellular carcinoma
- Randomized controlled trial