Page 321 - ebook HCC

PROGRAMME AND ABSTRACTSAND ABSTRACTS
318
318 PROGRAMME GENEVA, SWITZERLAND EASL HCC SUMMIT 319
FEBRUARY 13 - 16, 2014

Poster Board Number C82

SURVEILLANCE OF HEPATOCELLULAR NOTES
CARCINOMA: HOW IT WORKS IN CENTRAL
SLOVAKIA

Lubomir Skladany 1 2 3 4 , Janka Badinkova 1 2 3 4 ,
Svetlana A. Selcanova 1 2 3 4 , Stanislav Okapec 1 2 3 4
3
2
1 Hepatology/ Liver Transplantation, Oncology, Radiology, Surgery,
4
University Hospital, Banska Bystrica, Slovakia
Corresponding author’s e-mail: lubomir.skladany@gmail.com
Introduction: One randomized and several observational trials supported hypothesis that
surveillance (S) of hepatocellular carcinoma (HCC) lowers mortality probably via earlier
diagnosis (Dg) and therapy (Th).

Aims: According to guidelines relevant to study interval, S should have been performed
by semiannual ultrasonography (US). In an analysis of over 100 consecutive patients
(pts) with HCC from this centre only 23% were diagnosed by S. This has led authors to
evaluate the process of S in more detail: 1) in how many of indicated patients has the S
been actually performed; 2) what were the methods of S; 3) what was the outcome.

Methodology: Setting: Outpatient clinic of Liver Unit, regional university hospital in central
Slovakia. Inclusion process: Step 1 - december 2010: Electronic survey of the database
with key words …liver cirrhosis, chronic hepatitis B“; it gave rise to Group A: pts at HCC
risk, in whom S should have been recommended. Step 2 - Group B (pts with written
reccommended S) has been formed by manual analysis of Group A charts for signs of
S recommendation: yes/no; and S mode: 2a) at least 2 US exams in 6-monthly(mo)
intervals, 2b) at least 2 alpha-fetoprotein (AFP) exams, same intervals. Less than 2a) or
2b) was categorized as non-S. Step 3) Manual scrutiny of Group B charts for new lesions.
CLINICAL POSTER ABSTRACTS Results: Lenght of follow-up: 39mo (12-120). 1) Group A:445pts; exclusion CLINICAL POSTER ABSTRACTS
Exclusion criteria: Insufficient data/loss to follow-up.

criteria=52pts(12%); 2) Group B=393pts. Men:243 (62%), age:65,1years(y)(53-79).
Etiology of liver disease. ALD:153pts (39%), NASH:58 (15%), HBV:81 (21%), HCV:39
(10%), AIH:25 (6%), PSC:13(3%), cryptogenic=10(2,5%), PBC:7 (2%), others 7 (2%).
Surveillance has not been performed despite recommendation in 60pts (15%); in remaining
333pts with S, the mode has been US alone in 3pts (1%), AFP alone in 171 (51%) and
US+AFP in 139 (42%). 3) HCC was diagnosed in 10 of 393pts (2,5%), 7 men, age 56,5y.
HCC diameter - 45 mm (9-120).
Conclusion: This analysis of HCC-surveillance in central Slovakia has shown its very
serious reserves: 1) it is not recommended in 12% of indicated cases; 2) it is not performed
in 15% of recommendations; 3) it does not follow guidelines in vast majority of cases –
especially striking is overuse of allready disquallified (by guidelines) AFP; 4) therefore and
not surprisingly, diameter of lesions on HCC Dg is far from the goal. Action plan has been
conceived and is being realized.