Letter: hepatocellular carcinoma surveillance determines survival in patients at risk
EDITORS, Hepatitis B or C virus (HBV or HCV) infection, alcohol abuse, non alcoholic fatty liver disease, especially in the setting of established cirrhosis or advanced fibrosis, are the main risk factors for hepa tocellular carcinoma (HCC) Due to lack of typical symptoms and signs, more than 50% of HCC cases are diagnosed as intermediate or advanced stage disease and with poor long term survival. Earlier diagnosis of HCC should significantly improve survival. Official guidelines recommend HCC surveillance every 6 months in at risk individuals. However, the effectiveness of HCC surveillance remains a subject of debate, including intensity and mode of surveillance. Kim et al1 recently reported an interesting retrospective study. They included 1402 consecutive patients with newly diagnosed HCC and divided them into three groups: regular surveillance, patients with T2DM. HCC surveillance at 6 month intervals is recom mended based on the expected tumour growth rate (median doubling time of an HCC nodule is approximately 4 months)3,7,8 but not on the degree of risk of developing HCC. Therefore, reducing the screening interval for patients at higher risk may not add more benefit.9,10 As noted by Huo et al, only 14% of our NASH population had bridging fibrosis (F3) Furthermore, a low proportion of them died or were transplanted (8% or developed HCC (8% Thus, there were not enough patients with bridging fibrosis and clinical events to ex plore the effect of metformin in this subpopulation.
Alimentary pharmacology therapeutics