In Japan, Hashimoto et al. followed up the clinical course of 247 patients with non-alcoholic fatty liver disease (NAFLD) and noted concurrent hepatocellular carcinoma in 10 patients with cirrhosis. The 5-year cumulative incidence of hepatocellular carcinoma was 20% in F3–4 patients showing progression to liver fibrosis (LF1210229 level Selleckchem HDAC inhibitor 2b). Each of the above risk factors has been shown to independently

increase the risk of development of liver cancer, and the incidence of hepatocellular carcinoma is assumed to increase with an increasing number of risk factors. While it would be ideal to score these risk factors and quantitatively evaluate them, there is, at present, no adequately examined system for such quantitation. Furthermore, it would be desirable to specify a threshold for the annual rate of carcinogenesis at which screening should be started,

but that is also difficult at this point. Consequently, we select patients with usual type B or C chronic liver disease and patients with selleck kinase inhibitor cirrhosis of various etiologies as the target population for hepatocellular carcinoma screening. CQ5 Does regular screening of patients having risk factors for hepatocellular carcinoma improve the prognosis of hepatocellular carcinoma? Regular hepatocellular carcinoma screening leads to early detection of hepatocellular carcinoma, and in turn provides an opportunity for radical treatment. It may also MCE lead to improvement of the prognosis. (grade B) One RCT reported that regular hepatocellular carcinoma surveillance might have the effect of improving the prognosis of hepatocellular carcinoma (LF106251 level 1). Among patients with HBV infection, hepatocellular carcinoma was more frequently detected in the small nodule stage, the number of patients in whom hepatectomy was feasible was significantly higher, and the survival rate was significantly higher

in the group that underwent regular surveillance every 6 months by serum α-fetoprotein (AFP) measurement and ultrasonography as compared with the results in the group in whom such surveillance was not undertaken. The mortality rate also improved by 37%. Although not an RCT, a prospective study conducted only in patients with cirrhosis (LF019822 level 2a) also demonstrated that regular surveillance by ultrasonography and serum AFP measurement prolonged survival. Retrospective studies adjusted for lead-time bias (LF100863 level 2b, LF108494 level 2b, LF102745 level 2b) also reported that regular surveillance improved the survival rate; therefore, they demonstrated that regular surveillance might have a favorable effect on the prognosis.