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We read with great interest the leading article by Tremosini et al in Gut (2012 doi:10.1136/gutjnl-2011-301951) which prospectively assessed the diagnostic accuracy of an immunohistochemical panel (glypican 3, heat shock protein 70 and glutamine synthetase) in patients with cirrhosis with a small (5–20 mm) nodule detected by ultrasound screening.1 Finally, they established the clinical usefulness of that panel of markers for the diagnosis of early hepatocellular carcinoma (HCC). Then, something that logically or naturally follows from the early detection would be the treatment for early small HCC, that is, what the real role of each early modality plays in clinical practice.
Surveillance programmes for early detection of small nodular-type HCC have increased the number of patients suitable for surgical treatment. However, unlike other solid tumours, surgical resection plays a limited role in patients with HCC because of the lack of hepatic reserve as a result of coexisting cirrhosis or the presence of multiple tumours. Besides, liver …
Contributors We certify that we have participated sufficiently in the work to take public responsibility for the appropriateness of the design and method. In addition, all authors of this research paper have directly participated in the planning and execution, and the collection, analysis and interpretation of the data. Also, all authors of this paper have read and approved the final version submitted. ZY: data collection and elaboration, statistical analysis, writing of the manuscript; DY: data collection and elaboration, statistical analysis; JW: data collection and elaboration. ZY and DY contributed equally to this manuscript.
Competing interests None.
Ethics approval This was a meta-analysis, and all the included RCTs have obtained this approval from their own institutions.
Provenance and peer review Not commissioned; internally peer reviewed.