A Way to Spot Liver Cancer Sooner in Cirrhosis Patients

Ultrasound screening of liver cirrhosis patients detected liver cancer earlier

(RxWiki News) People with scarring of their liver (known as cirrhosis) are at risk for liver cancer. New research suggests there may be a way to detect this cancer earlier, thus improving survival odds.

The researchers found that cirrhosis patients lived longer, had their cancer diagnosed at an earlier stage and were more likely to receive treatment meant to cure their cancer (rather than treatment to ease symptoms of the disease) if they had regular ultrasounds compared with patients who did not have regular screenings.

"If you have cirrhosis of the liver, ask your physician about having regular ultrasounds."

Amit Singal, MD, of the Department of Internal Medicine at the University of Texas Southwestern Medical Center in Dallas, led this study.

Dr. Singal and colleagues searched MEDLINE between January of 1990 and January of this year for studies related to the topic. The researchers also searched for national meeting abstracts from 2009 to 2012.

This meta-analysis included previous studies looking at patients with liver cirrhosis and cancer and assessed how their survival was impacted by regular screening.

These researchers identified 47 studies including 15,158 patients.

Dr. Singal and team looked for patients with cirrhosis of the liver, which is a condition caused by infections, illness or heavy alcohol consumption. In those with this condition, the liver works less well as time goes on.

The researchers looked for data in which patients with cirrhosis were also diagnosed with hepatocellular cancer, which is the most common type of liver cancer.

Hepatocellular cancer (HCC) is one of the leading causes of death in people with cirrhosis, according to the study's investigators.

When they pooled the results of the studies, the researchers found that three-year survival was 50.8 percent among the 4,735 patients who were having an ultrasound bi-annually, and only 27.9 percent among the 6,115 patients who were not having regular ultrasounds.

Patients who are diagnosed with hepatocellular cancer early on have about a 70 percent chance of surviving five years if they receive a transplant, receive radiofrequency ablation (radiofrequency waves are used to destroy bad parts of the liver) or undergo surgery to remove part of their liver, the researchers noted.

The investigators reported that the American Association for the Study of Liver Disease and the European Association for the Study of the Liver have advocated for regular screenings in people who have a high risk for liver cancer, including patients with cirrhosis of the liver. However, they noted, studies show that surveillance in the United States is performed in less than 20 percent of these patients.

Dr. Singal and team also determined that fewer general practitioners screen these patients than do gastroenterologists (digestive system doctors) or hepatologists (liver specialists).

In their study, these researchers took into account lead time bias — the time when the disease would normally be diagnosed without screening to the time when a disease is diagnosed with screening. Sometimes, it’s thought that being diagnosed earlier increases survival but that is not always the case. They still concluded that patients with cirrhosis should be screened regularly.

There were a few problems with the studies included in this meta-analysis. For one, many patients were lost to follow-up, but the researchers noted that other studies support their findings.

“Overall, these findings provide sufficient evidence to support guidelines that recommend regular HCC surveillance for patients with cirrhosis,” they concluded.

This study appears in he journal PLOS Medicine.

There were no competing interests reported by the authors.

Review Date: 
April 1, 2014