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Hepatocellular carcinoma: is surveillance cost effective?
  1. J BRUIX,
  1. BCLC Group, Liver Unit, Hospital Clínic
  2. IDIBAPS, University of Barcelona, Catalonia, Spain
  1. Dr J Bruix, BCLC Group, Liver Unit, Hospital Clínic, University of Barcelona, Villarroel 170, 08036-Barcelona, Catalonia, Spain. jbruix{at}

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The development of hepatocellular carcinoma (HCC) constitutes a frequent event during the evolution of patients with liver cirrhosis (3–5% annual incidence rate) and constitutes their main cause of death.1 Survival is related to tumour stage at diagnosis and to the degree of impairment of liver function. Recent data have shown thatsurvival after diagnosis is not as poor as reported years ago.2 This is due both to advances in diagnosis even in the absence of effective treatment (lead time bias) and to the application of curative treatments (surgical resection, liver transplantation, and percutaneous ablation).2 These offer the only chance of cure but their applicability and long term success with five year survival exceeding 50% require the detection of HCC at an early stage, including patients with solitary nodules ⩽5 cm or up to three nodules each ⩽3 cm.2-5 In contrast, large/multifocal tumours are less likely to benefit from curative approaches and here three year survival falls below 50% regardless of treatment.2 The need for detection of HCC at an early stage has prompted surveillance programmes for patients with cirrhosis. HCC has most requisites for such a policy6: the population at risk is known, …

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