1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998–2009: A large population study

Ratib, Sonia; Fleming, Kate M; Crooks, Colin J; Aithal, Guruprasad P.; West, Joe

doi:10.1016/j.jhep.2013.09.027

Cited by 110 publications

(107 citation statements)

References 23 publications

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“…Commonly used diagnostic tests have poor sensitivity and specificity, are completed opportunistically or are not appropriate to be used within a community setting therefore limiting the opportunities for intervening at an earlier stage in the disease. This results in nearly 50% of patients only receiving their diagnosis of cirrhosis following an emergency admission to hospital with a decompensating event (7). A liver biochemistry panel often referred to as Liver function tests (LFTs) are inappropriately relied upon in the community setting to identify patients with asymptomatic chronic liver disease (8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of clinically significant liver disease within the general population, as defined by non-invasive markers of liver fibrosis: a systematic review

Harris

Harman

Card

et al. 2017

The Lancet Gastroenterology & Hepatology

153

127

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Section: Introductionmentioning

confidence: 99%

Prevalence of clinically significant liver disease within the general population, as defined by non-invasive markers of liver fibrosis: a systematic review

Harris

Harman

Card

et al. 2017

The Lancet Gastroenterology & Hepatology

153

127

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“…[2] Mortality in people with cirrhosis is high, with 5-year survival rates reported to be similar to that of bowel cancer. [3] However, contemporary knowledge of what people with cirrhosis die from and how this varies by aetiology of their cirrhosis is lacking. Such information can be important to demonstrate areas where premature mortality could be reduced and guide evidence-based practice in patient follow-up.…”

Section: Introductionmentioning

confidence: 99%

Causes of Death in People with Liver Cirrhosis in England Compared with the General Population: A Population-Based Cohort Study

Ratib

Fleming

Crooks

et al. 2015

American Journal of Gastroenterology

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(2015) Causes of death in people with liver cirrhosis in England compared to the general population: a population-based cohort study. American Journal of Gastroenterology, 110 . pp. 1149-1158. ISSN 1572 Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/28975/1/AJG-14-2130_manuscript_rev_v2.pdf Copyright and reuse:The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the University of Nottingham End User licence and may be reused according to the conditions of the licence. For more details see: http://eprints.nottingham.ac.uk/end_user_agreement.pdf A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription.

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“…The assumptions made here are optimistic and to implement surveillance effectively would require diagnosis of individuals with cirrhosis before liver failure manifests as has been recommended in the NICE cirrhosis guideline. 12 Currently, only 50% of diagnoses of cirrhosis are made before the onset of liver failure 25 and this indicates that the impact of surveillance today will be substantially less than the estimate above. This clearly identifies the limitations to surveillance as it currently stands.…”

mentioning

confidence: 99%

Surveillance for hepatocellular cancer

Roskilly

Rowe

2018

Clinical Medicine

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high in patients with cirrhosis who develop HCC. 8 Mortality data from the UK for HCC demonstrates that this is rising in parallel with the incidence rates of HCC such that in 2015 there were approximately 1,700 deaths due to HCC. Since cirrhosis is readily identified and the risk of HCC is known, regular surveillance testing using ultrasound scanning is proposed to identify HCC early and to facilitate curative treatment.9 This rationale is supported by many international guidelines for the management of patients with cirrhosis including the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD), as well as by recent guidance issued by the National Institute for Health and Care Excellence (NICE). 10-12 However, the recommendation that patients with cirrhosis have regular surveillance for HCC is not universally accepted and the majority of patients do not receive surveillance. 13-15The imperative for surveillanceMany international authorities, including the AASLD and the EASL recommend that high risk groups are entered into surveillance programmes. This includes the majority of patients with cirrhosis but not those with advanced liver failure unless they are on the transplant waiting list. Patients with non-cirrhotic HBV infection and patients with HCV infection and advanced fibrosis (defined as fibrosis stage 3 [out of 4, where 4 is cirrhosis]) are also recommended to have surveillance due to the increased incidence of HCC in these groups. 11 Surveillance of individuals without cirrhosis will not be discussed further in this article. Surveillance relies on the ideal that if we detect early asymptomatic cancers, curative treatment options are available to these patients. These treatments include resection, transplantation and radiofrequency ablation, each of which can achieve 5-year survival rates near 70% for small lesions, <2.5 cm in diameter.9 Recurrent HCC is frequently observed after liver resection and ablation since the development of HCC is associated with the underlying cirrhosis and that cirrhosis is not treated or targeted by local therapies. Liver transplantation offers a real prospect of cure for these patients; however, in practice this option is limited in applicability due to comorbidity and limited in availability due to a shortage of donor organs. Current provision of surveillanceReports of HCC surveillance in patients with cirrhosis consistently show poor uptake and adherence to the published guidance. A UK survey confirmed these international findings and showed that current surveillance for HCC is poor, provision is ad hoc and there Hepatocellular carcinoma (HCC) is a common complication of cirrhosis. The incidence of HCC is rising and HCC-related mortality is rising in parallel such that there were more than 1,700 deaths in the UK in 2015. Since cirrhosis is a known risk factor for the development of HCC and early diagnosis is associated with improved outcomes, surveillance for the development of HCC using regular ultrasou...

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1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998–2009: A large population study

Cited by 110 publications

References 23 publications

Prevalence of clinically significant liver disease within the general population, as defined by non-invasive markers of liver fibrosis: a systematic review

Prevalence of clinically significant liver disease within the general population, as defined by non-invasive markers of liver fibrosis: a systematic review

Causes of Death in People with Liver Cirrhosis in England Compared with the General Population: A Population-Based Cohort Study

Surveillance for hepatocellular cancer

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