#Surveillance must be done in a population with high risk of that disease. Nevertheless, patients at the higher end of the spectrum (e.g., cirrhosis with Child-Pugh C) carry a restricted #prognosis even with radical therapies. @EleanorBarnesOx @CR_UK @NIHRresearch 1/7
Cirrhotic patients with advanced liver failure or Child-Pugh B with #decompensation are usually not screened for HCC because they could not tolerate effective therapies. This changes if they are listed for transplant, however. 2/7
HCC onset can trigger changes in priority on the list as well as lend someone ineligible for #transplant. It is important, therefore, to maintain surveillance of HCC for this population. 3/7
For non-cirrhotic patients, the recommendation varies depending on the aetiology. Patients with #HBV infection are at risk of progression to HCC even without cirrhosis, but no model has been able to adequately define when screening should start. 4/7
Studies in patients with NASH, ArLD, autoimmune liver diseases, genetic haemochromatosis, alpha-1-antitrypsin deficiency and Wilson’s disease all suggest that HCC arises on cirrhotic livers, hence there’s no recommendation to undergo surveillance. 5/7
Finally, if there is evidence of advanced (bridging) fibrosis in the context of #HCV infection (Metavir F3), patients should be included in an HCC surveillance programme. Even if they achieve sustained viral response, screening should not be stopped. 6/7
Next week we will talk more about tests used for HCC screening. Keep in touch! 7/7
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