A 6-month versus a 12-month surveillance for hepatocellular carcinoma in 559 hemophiliacs infected with the hepatitis C virus

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Blood First Edition Paper

prepublished online March 20, 2003; DOI 10.1182/blood-2002-10-3310

102/1/78 (most recent)

2002-10-3310v1

Blood, 1 July 2003, Vol. 102, No. 1, pp. 78-82

CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS

A 6-month versus a 12-month surveillance for hepatocellular carcinoma in 559

hemophiliacs infected with the hepatitis C virus

Elena Santagostino, Massimo Colombo, Rivi, Grazia Rumi, Angiola

Rocino, Silvia Linari and Pier Mannuccio Mannucci the Study Group of the

Association of Italian Hemophilia Centers

From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and

Department of Internal Medicine, and the Division of Hepatology and

Department of Gastroenterology, IRCCS Maggiore Hospital, University of

Milan, Italy; the Department of Hematology and Hemophilia Center, San

Giovanni Bosco Hospital, Naples, Italy; and the Department of Hematology and

Hemophilia Center, Careggi Hospital, Florence, Italy.

Hepatocellular carcinoma (HCC) is an increasingly frequent cause of

mortality in hemophiliacs with chronic viral hepatitis. Early diagnosis of

the tumor at an initial stage is known to improve the outcome of HCC

treatment. Because all HCC cases detected in a previous study based upon

annual ultrasound (US) surveillance of hemophiliacs with elevated alanine

aminotransferase levels were multinodular, this study was designed to

evaluate if a more intense surveillance with US and alphafetoprotein (AFP)

serum levels of all the patients infected with the hepatitis C virus (HCV)

improved the identification of single nodule tumors. A multicenter cohort of

559 HCV-infected hemophiliacs was divided into 2 arms, one followed up at

6-month intervals and one at 12-month intervals depending on the choice and

available facilities of each treatment center. During a 6-year surveillance

period, HCC was diagnosed in 5 (2.4%) of 210 patients in the 6-month group

and in 3 (0.9%) of 349 patients in the 12-month group. The overall incidence

rate of HCC was 239 per 100 000 per year (397 per 100 000 per year in the

6-month group and 143 per 100 000 per year in the 12-month group;

differences not statistically significant). By multivariate analysis, HCC

risk was increased 12.9-fold with alcohol intake more than 80 g/d and

15.2-fold with AFP levels higher than 11 ng/mL. Liver-related death occurred

in 8 cases (1.4%), including 3 with HCC. Still alive and tumor free after 24

to 34 months from diagnosis are 3 patients with multinodular tumors treated

with repeat chemoembolization followed by orthotopic liver transplantation.

In conclusion, 6-month surveillance with US did not increase the chances of

detection of single nodule tumors, but it is reasonable to assume that

successful treatment of multinodular tumors based upon debulking with

chemoembolization and liver transplantation was facilitated by this

approach. (Blood. 2003;102:78-82)