Silent cirrhosis in patients with hepatocellular carcinoma. Implications for screening in high-incidence and low-incidence areas.

We assessed the frequency of silent (i.e., clinically asymptomatic) cirrhosis among 305 patients with hepatocellular carcinoma (HCC) and cirrhosis in relation to the patients' country of birth, the cause of the cirrhosis, clinical features, and hepatitis B surface antigen (HBsAg) status. Overall, 56% of the patients had silent cirrhosis, but this occurred significantly more frequently among those born in areas of the world where HCC is common (64% compared with 36%), those who were HBsAg-seropositive (75% compared with 25%), and those who had cryptogenic cirrhosis (71% compared with 29%). Previously recognized ("known") cirrhosis was more common among those from low-incidence areas (52% compared with 36%) and the cause of the cirrhosis was more often alcoholic (44% compared with 10%). The clinical features at the time of presentation with HCC did not differ between the two groups. During the 10-year period of the study (1978 to 1988), 448 patients with HCC were seen (including those without cirrhosis and those in whom the presence or absence of cirrhosis could not be determined). Overall, therefore, cirrhosis was recognized before presentation with tumor in only 30% of the patients. The screening of cirrhotic patients can only have a limited impact on the early detection of HCC.