Risk-Based Screening of Hepatocellular Cancer in the Krasnoyarsk Region: The First Results

Aim: to assess the prevalence of hepatocellular carcinoma in patients at moderate and high risk in the Krasnoyarsk Territory during screening activities carried out by the oncology service.

Materials and methods. To implement a risk-based approach, the study included men and women aged 40– 70 years with F3–F4 fibrosis or cirrhosis of the liver, regardless of etiology, who signed an informed consent to participate in the study and those with a previously diagnosed hepatocellular carcinoma. The development program and routing algorithms were developed by the Interdisciplinary Society of Liver Tumor Specialists and approved by the Ministry of Health of the Krasnoyarsk Territory. The screening was conducted at the Krasnoyarsk Regional Oncology Dispensary. Methods used: a questionnaire to collect information about risk factors (the presence of cirrhosis, its causes, concomitant diseases, bad habits); blood sampling to determine the level of AFP (alpha-fetoprotein) + PIVKA-II (protein induced by vitamin K absence or antagonist-II) (Cobas, Roche, Switzerland); the use of the GAAD algorithm, combining gender, age, AFP and PIVKA-II levels with further risk stratification for differentiation of risk groups; instrumental diagnosis — MRI with hepatospecific contrast (gadoxetic acid). The data was processed using Statistica and StatTech statistical packages. The normal distribution was evaluated using the Shapiro — Wilk and Kolmogorov — Smirnov criteria. The results are described by averages, standard deviations, median, and quartiles.

Results. A total of 746 patients took part in the risk-oriented early diagnosis program; hepatocellular cancer was detected in 14 patients, with 50 % of cases occurring at early stages (I–II), indicating the high sensitivity of the chosen approach. The detection rate of malignant tumors during the conducted measures was 1.88 %. The pilot screening project influenced the unification of specialists into a multidisciplinary team, which in turn contributed to an increase in the number of surgical methods for treating hepatocellular carcinoma by 16.5 % and the number of liver biopsies by 33.2 %.

Conclusions. The introduction of a risk-based approach for a high-risk group using more sensitive diagnostic methods helps to increase the proportion of early stages and timely initiation of specialized treatment. The GAAD calculator is an effective method for identifying a high-risk group for hepatocellular carcinoma, where the use of MRI is justified as a sensitive method for early diagnosis of liver cancer.

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