To the Editor:The paper concerning surveillance programmes for hepatocellular carcinoma (HCC) in the journal needs one clarification (1).Indeed, survival is lower when the diagnosis is made late than soon, and when the patient is older. However, this does not demonstrate the usefulness of surveillance. Several biases exist, the main being the lead-time bias. Again, here is an example concerning HCC. In a recent study, screened patients died 18 months earlier than non-screened ones; nevertheless, the authors concluded that screening improved survival (2)! Numerous studies have investigated screening; all were negative or inconclusive (3, 4).Moreover, at present, no randomized-controlled trials are available to choose potentially curative treatments for small HCC: transplantation, resection and local ablation.
Authors: Sonia Pascual; Javier Irurzun; Pedro Zapater; José Such; Laura Sempere; Fernando Carnicer; Jose María Palazón; Pedro de la Iglesia; Santiago Gil; Francisco de España; Miguel Perez-Mateo Journal: Liver Int Date: 2008-05 Impact factor: 5.828
Authors: Franco Trevisani; Valentina Santi; Annagiulia Gramenzi; Maria Anna Di Nolfo; Paolo Del Poggio; Luisa Benvegnù; Gianludovico Rapaccini; Fabio Farinati; Marco Zoli; Franco Borzio; Edoardo Giovanni Giannini; Eugenio Caturelli; Mauro Bernardi Journal: Am J Gastroenterol Date: 2007-07-07 Impact factor: 10.864