Introduction The global incidence of HCC is rising and it is the third most common cause of cancer-related death worldwide. Surveillance of at risk patients has been recommended by expert guidelines to detect early cancers that are amenable to curative treatments. AASLD has recommended HCC surveillance for non-cirrhotic HBV-positive Asian males over 40 and females over 50yrs of age. However, the evidence to support this recommendation is limited and is derived from studies conducted in Asia. Results from such studies may not be applicable in the West, due to differences in environmental risk factors and availability of HBV treatment. Implementation of such a recommendation would place a burden on healthcare resources, and may not be justified if the risk for HCC is substantially lower than previous estimates in this population.
Methods A retrospective study was carried out of all Asian patients undergoing follow up for HBV infection from 1990 to 2012. Patients were classified as cirrhotic or non-cirrhotic according to clinical, biochemical, radiological and histological results. Follow-up was until September 2012, and was censored at time of death, development of cirrhosis or loss to follow-up.
Results Among 316 identified Asian patients with HBV, 73 non-cirrhotic patients fulfilled the proposed AASLD surveillance criteria, either at time of initial referral or during the period of follow-up. The median at-risk follow up period (as defined by AASLD guidelines for non-cirrhotic Asians) was 57 months (range: 0–354 months). HCC was diagnosed in one non-cirrhotic patient after 77 months of follow up (male, 60yrs), two patients became cirrhotic after 49 and 89 months (male, age 46 and 55yrs) and no deaths occurred. The overall incidence of HCC in the non-cirrhotic cohort meeting the AASLD surveillance criteria was 1 per 429.5 patient-years of follow-up (0.23% per patient-year).
Conclusion The incidence of HCC in Asian patients with non-cirrhotic HBV is low in our cohort. This low incidence challenges the rationale for surveillance in this group of patients. More studies are needed to assess the benefit of such approach.
Disclosure of Interest None Declared.
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