HEPATOCELLULAR-CARCINOMA IN LIVER-CIRRHOSIS - A PROSPECTIVE-STUDY

From January 1984 to December 1991 we carried out a prospective surveillance of the development of hepatocellular carcinoma (HCC) in 200 cirrhotic patients, monitored from the first histologic diagnosis of cirrhosis. Real-time ultrasonography (US) and serum alpha-fetoprotein (AFP) assays were performed every 3-6 months. During this period we detected HCC in 38 patients. The overall cumulative incidence of HCC in the 8 years was 41%, with a yearly incidence of 5.1%. Eighteen of 38 patients (48%) had a tumor <5 cm in diameter. AFP reached diagnostic levels (>500 ng/ml) in eight cases only (21%) Patients with initial AFP values >20 ng/ml developed HCC more frequently than patients with value less-than-or-equal-to 20 ng/ml; the percentage of HCC was statistically higher (p<0.01) in patients in Child's B and than in Child's A class. A periodic follow-up, using US and AFP, is suggested for the early diagnosis of HCC in cirrhotic patients.