Measurements: Hepatocellular carcinoma incidence and mortality starting 1 year after diagnosis of alcoholic cirrhosis through 2009; ratio of HCC-related mortality to total mortality. Results: Among 8482 patients, 169 developed HCC. A total of 5734 patients died, 151 of whom had developed HCC. Five-year cumulative

HCC risk was 1.0% (95% CI, 0.8% to 1.3%), and 5-year cumulative mortality was 43.7% (CI, 42.6% to 44.7%). Only 1.8% of all deaths were HCC-related. In sensitivity analyses that included all possible HCC diagnoses and a subpopulation of patients who were followed by hepatologists, the highest 5-year HCC risk was 1.9% (CI, 0.8% to 3.9%). These patients did not have higher mortality than patients in the nationwide cohort. Limitation: Cirrhosis and HCC diagnoses were made by hospital physicians without uniform clinical criteria, and use of registry data precluded drug discovery detailed information on clinical care of patients, selleckchem including HCC surveillance. Conclusion: Danish patients with alcoholic cirrhosis have a low risk for HCC, and HCC contributes little to

their high mortality. On the basis of these data, HCC surveillance would be expected to have a minimal effect on mortality and is unlikely to be cost-effective. Primary Funding Source: None. This article in the Annals of Internal Medicine1 raises questions about who requires hepatocellular carcinoma (HCC) screening. The ultimate objective of a cancer screening program is reduction in mortality from that cancer. This can only be definitively demonstrated by a randomized controlled trial. Studies relying on surrogate endpoints (duration of survival, stage migration, or ability to apply potentially curative treatment) cannot provide conclusive evidence that screening saves lives. Despite this, it would seem obvious that early diagnosis of HCC should result in decreased mortality. This is because, unlike other cancers for which screening programs are in place, treatment of any but the earliest stages of HCC is usually ineffective. Other cancers that we screen for (breast, colon, prostate, cervix) have effective treatment for even moderately advanced cases. Death from the underlying

上海皓元医药股份有限公司 liver disease complicates assessing the benefits of screening for HCC. Therefore, knowing that a patient is at increased risk of HCC is not in itself sufficient to warrant screening. Other potential considerations include that the risk has to be sufficiently high, and screening and treatment of screen-detected lesions sufficiently effective, that mortality is reduced. There is no benefit to screening if the likelihood of cure is small. The benefit of HCC screening has been evaluated in two randomized controlled trials in patients with chronic hepatitis B.2, 3 The first was inconclusive because patients diagnosed with HCC frequently did not receive appropriate treatment.2 The second trial has some methodological flaws, but did show a benefit to HCC screening.