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Surveillance for hepatocellular carcinoma in liver cirrhosis: have programmes improved because patients have?
  1. E Giannini,
  2. R Testa
  1. Gastroenterology Unit and Postgraduate School of Gastroenterology and Digestive Endoscopy, Department of Internal Medicine, University of Genoa, Italy
  1. Correspondence to:
    Professor R Testa, Gastroenterology Unit, Department of Internal Medicine, University of Genoa, V le Benedetto XV, No 6, 16132 Genoa, Italy;

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In their commentary (Gut 2001;48:149–50), Bruix and Llovet discuss the paper by Bolondi et al (Gut 2001;48:251–9) and emphasise the fact that survival in patients with hepatocellular carcinoma (HCC) is mainly related to tumour stage and degree of liver function impairment at diagnosis. This is most likely true because of the peculiar features of HCC, which almost inevitably arises in the “minefield” of a cirrhotic liver whose residual function is one of the main factors influencing therapeutic options and prognosis.1

Nevertheless, a trend towards increased survival after diagnosis of HCC has recently been observed, although the surveillance programme has not changed over the years (liver ultrasonography and α-fetoprotein determination every six months). As Bruix and Llovet affirm, this increase in survival may be due to advances in diagnosis even in the absence of effective treatment, to the availability of multiple treatment, or both.

However, it must be emphasised that HCC stage (parameter of the tumour) …

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