Hepatocellular carcinoma and unknown cirrhosis

n Italy the incidence of hepatocellular-carcinoma (HCC) in patients with liver cirrhosis is estimated approximately 5% per year. The new imaging technologies make it possible to perform screening programs for the early detection of HCC in these patients; early diagnosis of HCC is recommended as the best strategy in order to enable surgical approach, which seems to be the only effective therapy: screening programs must consider the cost-benefit ratio in the choice of patients and standards of investigation. In the Japanese authors' opinion all patients with liver cirrhosis must be screened every three months with an ultrasonographic liver examination (US) and a measurement of serum alpha-1-fetoprotein level (AFP) and every nine months with a computed tomography (CT) of the liver: at a 5% annual incidence of HCC the cost of a single diagnosis is estimated about 8000 +. In our opinion the cirrhotic patients in Child's C class (approximately 20%) can be excluded from the screening programs, since the survival expectation of these patients is always poor, whether HCC is present or not. Furthermore, considering the acknowledged reliability of the US in the detection of space occupying lesions of the liver, periodical CT examination seems to be unproductive. AFP has a low sensibility as a marker of HCC; nevertheless a progressive increase of its levels can be considered an index of possible blastomatous transformation of cirrhotic liver. In comparison with the Japanese screening programs, the proposed changes might obtain a 55% reduction of the cost of a single diagnosis of HCC, without significant diagnostic loss.(ABSTRACT TRUNCATED AT 250 WORDS)