Carlos Rodríguez de Lope1, María Reig2, Ana Matilla3, María Teresa Ferrer4, Eva Dueñas5, Beatriz Mínguez6, Javier F Castroagudín7, Inmaculada Ortiz8, Sonia Pascual9, José Luis Lledó10, Adolfo Gallego11, Juan I Arenas12, Carles Aracil13, Montserrat Forne14, Carolina Muñoz15, Fernando Pons16, Margarita Sala17, Mercedes Iñarrairaegui18, Marta Martin-Llahi19, Victoria Andreu20, Carmen Garre21, Paloma Rendón22, Javier Fuentes23, Javier Crespo1, Manuel Rodríguez24, Jordi Bruix2, María Varela25. 1. Servicio de Digestivo, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, España. 2. Servicio de Hepatología, Hospital Clínic, Barcelona Clinic Liver Cancer (BCLC), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España. 3. Servicio de Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España. 4. Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España. 5. Servicio de Digestivo, Sección de Hepatología, Hospital de Bellvitge, Universitat Autónoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España. 6. Servicio de Medicina Interna-Hepatología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autónoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, España. 7. Servicio de Digestivo, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España. 8. Servicio de Digestivo, Hospital Dr. Peset, Valencia, España. 9. Unidad Hepática, Servicio de Digestivo, Hospital General Universitario de Alicante, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Alicante, España. 10. Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Ramón y Cajal, Madrid, España. 11. Servicio de Digestivo, Hospital de la Santa Creu i Sant Pau, Barcelona, España. 12. Servicio de Digestivo, Hospital General Universitario de Donosti, San Sebastián, Guipúzcoa, España. 13. Servicio de Digestivo, Hospital Universitario Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España. 14. Servicio de Digestivo, Mútua de Terrassa, Terrassa, Barcelona, España. 15. Sección de Hepatología, Servicio de Digestivo, Hospital 12 de Octubre, Madrid, España. 16. Sección de Hepatología, Servicio de Digestivo, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España. 17. Servicio de Digestivo, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, España. 18. Sección de Hepatología, Servicio de Medicina Interna, Clínica Universitaria de Navarra, Pamplona, Navarra, España. 19. Servicio de Aparato Digestivo, Hospital Moisés Broggi, Sant Joan Despí, Barcelona, España. 20. Servicio de Digestivo, Hospital de Viladecans, Viladecans, Barcelona, España. 21. Servicio de Aparato Digestivo, Hospital Virgen de la Arrixaca, Murcia, España. 22. Servicio de Digestivo, Hospital Universitario Puerta del Mar, Cádiz, España. 23. Servicio de Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España. 24. Sección de Hepatología, Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, España. 25. Sección de Hepatología, Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, España. Electronic address: maria.varelac@sespa.es.
Abstract
BACKGROUND AND OBJECTIVE: In 2010 we published that 53% of cases of hepatocellular carcinoma (HCC) detected in Spain were diagnosed outside the context of standard screening programs, which consequently leads to lower survival rates. The aim of this study was to analyze the current situation and the causes of diagnosis out of screening programs. MATERIAL AND METHODS: Prospective registry of 73 second- and third-level Spanish healthcare centers carried out between October 1, 2014 and January 31, 2015. The baseline characteristics of the disease and the first treatment administered for the incidental primary liver tumors during such period were recorded. RESULTS: A total of 720 patients were included in the study: HCC (n=686), intrahepatic cholangiocarcinoma (n=29), hepatic cholangiocarcinoma (n=2), other (n=3). HCC characteristics: male 82%; mean age 67 years; cirrhosis 87%; main etiologies: alcohol 35%, HCV 30%, alcohol and HCV 15%, non-alcoholic fatty liver disease 6%; tumor stage: BCLC-0 11%, A 43%, B 19%, C 16% and D 11%; first treatment: transarterial chemoembolization (23%), percutaneous ablation (22%), symptomatic treatment (20%), resection (11%), sorafenib (11%). Three hundred and fifty-six patients (53%) were diagnosed outside of screening programs, mainly owing to the fact that they suffered from an undiagnosed liver disease (76%) and to the poor adherence to the screening program (18%). These patients were mainly male (P<.001), with an alcoholic etiology (P<.001) and active alcohol consumption (P<.001). Moreover, the disease was predominantly diagnosed at more advanced stages (P<.001) and was addressed with less radical treatments (P<.001). CONCLUSIONS: In Spain, the main cause of diagnosis of a HCC outside the context of a screening program is the absence of a prior diagnosis of a liver disease, particularly in alcohol-consuming men. Detecting a liver disease in asymptomatic populations and improving adherence to screening programs are the main areas that must be subject to improvement in order to improve the early detection of HCC.
BACKGROUND AND OBJECTIVE: In 2010 we published that 53% of cases of hepatocellular carcinoma (HCC) detected in Spain were diagnosed outside the context of standard screening programs, which consequently leads to lower survival rates. The aim of this study was to analyze the current situation and the causes of diagnosis out of screening programs. MATERIAL AND METHODS: Prospective registry of 73 second- and third-level Spanish healthcare centers carried out between October 1, 2014 and January 31, 2015. The baseline characteristics of the disease and the first treatment administered for the incidental primary liver tumors during such period were recorded. RESULTS: A total of 720 patients were included in the study: HCC (n=686), intrahepatic cholangiocarcinoma (n=29), hepatic cholangiocarcinoma (n=2), other (n=3). HCC characteristics: male 82%; mean age 67 years; cirrhosis 87%; main etiologies: alcohol 35%, HCV 30%, alcohol and HCV 15%, non-alcoholic fatty liver disease 6%; tumor stage: BCLC-0 11%, A 43%, B 19%, C 16% and D 11%; first treatment: transarterial chemoembolization (23%), percutaneous ablation (22%), symptomatic treatment (20%), resection (11%), sorafenib (11%). Three hundred and fifty-six patients (53%) were diagnosed outside of screening programs, mainly owing to the fact that they suffered from an undiagnosed liver disease (76%) and to the poor adherence to the screening program (18%). These patients were mainly male (P<.001), with an alcoholic etiology (P<.001) and active alcohol consumption (P<.001). Moreover, the disease was predominantly diagnosed at more advanced stages (P<.001) and was addressed with less radical treatments (P<.001). CONCLUSIONS: In Spain, the main cause of diagnosis of a HCC outside the context of a screening program is the absence of a prior diagnosis of a liver disease, particularly in alcohol-consuming men. Detecting a liver disease in asymptomatic populations and improving adherence to screening programs are the main areas that must be subject to improvement in order to improve the early detection of HCC.
Authors: Ângelo Zambam de Mattos; Jose D Debes; Andre Boonstra; Ju-Dong Yang; Domingo C Balderramo; Giovana D P Sartori; Angelo Alves de Mattos Journal: World J Gastroenterol Date: 2021-06-28 Impact factor: 5.742