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KMID : 0614720150580050385
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Journal of Korean Medical Association
2015 Volume.58 No. 5 p.385 ~ p.397
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The Korean guideline for hepatocellular carcinoma surveillance
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Kim Do-Young
Kim Hyun-Jung
Jung Seung-Eun
Kim Sang-Gyune
Kim Hyung-Joon
Sinn Dong-Hyun
Lee Yong-Joo
Jeong Woo-Kyoung
Choi Kui-Son
Heo Nae-Yun
Kim Dong-Joon
Kim Young-Seok
Kim Yong-Bum
Kim Yoon-Jun
Kim Hyoung-Ryoul
Park Min-Seon
Lee Chan-Wha
Tak Won-Young
Chung Ji-Hye
Kim Soo-Young
Kim Yeol
Lee Won-Chul
Kim Hong-Soo
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Abstract
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Hepatocellular carcinoma (HCC) is one of the major cancers with a high incidence and mortality in Korea. A Korean
multidisciplinary collaborative committee consisting of hepatologists, radiologists, epidemiologists and family medicine
doctors systematically reviewed clinical practice guidelines in the world and literatures. The level of evidence for each
recommendation was assessed and discussed to reach a consensus. Meta-analysis was also conducted to evaluate
the grade of recommendation for the five key questions. Several randomized controlled studies and cohort studies
showed a survival gain associated with surveillance for those at risk of developing HCC. The target populations for HCC
surveillance were identified as hepatitis B virus or hepatitis C virus carriers and cirrhotic patients, since numerous studies
revealed that these patients have significantly higher risk of HCC compared with non-infected or non-cirrhotic controls.
Individual surveillance strategy according to treatment history or degree of fibrosis in patients with viral hepatitis remains
to be settled. Based on several cohort and randomized studies, a surveillance interval of six months was recommend.
The starting age of surveillance was determined as 40 years from the epidemiologic data. Although ultrasonography
(US) is the mainstay for detection of HCC, its sensitivity is not fully accepted. Measurement of serum alpha-fetoprotein
can complement US examination, increasing the sensitivity of HCC detection. The recommendation for HCC surveillance
is that those with hepatitis B virus (or hepatitis C virus) infection or cirrhosis should have liver US and serum alphafetoprotein
measurement every six months from 40 years of age or at the time of diagnosis of cirrhosis.
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KEYWORD
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Hepatocellular carcinoma, Surveillance, Ultrasonography, Alpha-fetoprotein
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