A recent review by doctors at University of Texas Southwestern Medical Center has shown that liver cancer survival rates could be improved if people with cirrhosis are more frequently screened for tumors using inexpensive ultrasound scans and blood tests.
Hypothesizing that hepatocellular cancer, the most frequent form of primary liver cancer, tends to be untreatable when it is diagnosed at a late stage, researchers at UTSW performed a systematic literature review, analyzing 47 studies that involved over 15,000 patients. The study, published in the Public Library of Science Medical Journal, found that the three-year survival rate estimated for liver cancer patients became much higher for those who received screening: 51% of the patients who were screened beat the average survival rate, compared to only 28% of unscreened patients.
In addition, researchers found that cirrhosis patients who had undergone surveillance for liver cancer were more likely to receive cure treatments, rather than palliative or end-of-life care.
Ultimately, these findings show that hepatic cancer surveillance is linked to significant improvements in early tumor detection, receipt of curative treatment, and overall survival among patients with cirrhosis. Although the findings are sufficient to recommend regular surveillance for cirrhosis patients, researchers emphasise, however, that these results must be interpreted cautiously, since many of the studies included in their analysis had insufficient follow-up to assess survival adequately and none of the studies measured potential downstream harms of liver cancer surveillance, such as complications of liver biopsies.
Dr. Amit Singal, Assistant Professor of Internal Medicine and Clinical Sciences and Medical Director of the Liver Tumor Clinic in the Harold C. Simmons Cancer, stresses the importance of screening, since curative therapies, such as surgery or a liver transplant, “are only available if patients are found to have liver cancer at an early stage.”
The third most deadly cancer, liver cancer has motivated researchers to look for improvements in detection and treatment, particularly in Texas. BioNews Texas recently reported that Intrinsic Imaging has been awarded a global clinical trial to assess patients with hepatocellular carcinomas.
Each year, up to 5 percent of people with cirrhosis develop liver cancer, a rate that is increasing faster than almost all solid tumors in the U.S. For Texas, a state with high rates of fatty liver disease and Hepatitis C (both of wich are correlated with cirrhosis) and the second state with the highest incidence of hepatocellular carcinoma, Dr. Singal’s findings assume particular importance.
Although there is a simple and painless abdominal ultrasound test available, less than 20% of at-risk people have dont this test, Dr. Singal notes, adding that this is due mainly to providers failing to order it. With this new study, he hopes to encourage both patients and doctors to request the test.
The fact that liver cancer screening is not yet recommended by the United States Preventative Services Task Force is partly explained because a randomized study has not yet been done. When a randomized study was attempted in 2005, many patients opted out when they heard evidence that liver cancer screening could be so beneficial. None of the patients wanted to be the ones randomly chosen to not get the tests.
But the fact that a randomized trial doesn’t exist doesn’t mean that there isn’t a benefit, Dr. Singal says. His goal is therefore to provide evidence to both patients and physicians that liver cancer screening is beneficial.