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Prepublished online as a Blood First Edition Paper on March 20, 2003; DOI 10.1182/blood-2002-10-3310. This Article Full Text Full Text (PDF) All Versions of this Article: 2002-10-3310v1 102/1/78    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Santagostino, E. Articles by Mannucci, P. M. Search for Related Content PubMed PubMed Citation Articles by Santagostino, E. Articles by Mannucci, P. M. Related Collections Hemostasis, Thrombosis, and Vascular Biology Neoplasia Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 1 July 2003, Vol. 102, No. 1, pp. 78-82 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS A 6-month versus a 12-month surveillance for hepatocellular carcinoma in 559 hemophiliacs infected with the hepatitis C virus Elena Santagostino, Massimo Colombo, Monica Rivi, Maria Grazia Rumi, Angiola Rocino, Silvia Linari, and Pier Mannuccio Mannucci, the Study Group of the Association of Italian Hemophilia Centers From the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Department of Internal Medicine, and the Division of Hepatology and Department of Gastroenterology, IRCCS Maggiore Hospital, University of Milan, Italy; the Department of Hematology and Hemophilia Center, San Giovanni Bosco Hospital, Naples, Italy; and the Department of Hematology and Hemophilia Center, Careggi Hospital, Florence, Italy. Hepatocellular carcinoma (HCC) is an increasingly frequent cause of mortality in hemophiliacs with chronic viral hepatitis. Early diagnosis of the tumor at an initial stage is known to improve the outcome of HCC treatment. Because all HCC cases detected in a previous study based upon annual ultrasound (US) surveillance of hemophiliacs with elevated alanine aminotransferase levels were multinodular, this study was designed to evaluate if a more intense surveillance with US and alphafetoprotein (AFP) serum levels of all the patients infected with the hepatitis C virus (HCV) improved the identification of single nodule tumors. A multicenter cohort of 559 HCV-infected hemophiliacs was divided into 2 arms, one followed up at 6-month intervals and one at 12-month intervals depending on the choice and available facilities of each treatment center. During a 6-year surveillance period, HCC was diagnosed in 5 (2.4%) of 210 patients in the 6-month group and in 3 (0.9%) of 349 patients in the 12-month group. The overall incidence rate of HCC was 239 per 100 000 per year (397 per 100 000 per year in the 6-month group and 143 per 100 000 per year in the 12-month group; differences not statistically significant). By multivariate analysis, HCC risk was increased 12.9-fold with alcohol intake more than 80 g/d and 15.2-fold with AFP levels higher than 11 ng/mL. Liver-related death occurred in 8 cases (1.4%), including 3 with HCC. Still alive and tumor free after 24 to 34 months from diagnosis are 3 patients with multinodular tumors treated with repeat chemoembolization followed by orthotopic liver transplantation. In conclusion, 6-month surveillance with US did not increase the chances of detection of single nodule tumors, but it is reasonable to assume that successful treatment of multinodular tumors based upon debulking with chemoembolization and liver transplantation was facilitated by this approach. (Blood. 2003;102:78-82) CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

	Copyright © 2003 by American Society of Hematology         Online ISSN: 1528-0020