Adherence to a Semiannual Surveillance Program for Hepatocellular Carcinoma in Patients With Liver Cirrhosis

Abstract

The adherence to the process of HCC surveillance can be considered as adequate among cirrhotic patients. Active alcohol consumption and a history of intravenous drug use are the strongest predictors of suboptimal adherence. These patients have a more advanced HCC stage at diagnosis and tend to be less frequently treated with curative intention.

Incidence and risk factors associated with hepatocellular carcinoma surveillance failure

“…However, in the present series, the proportion of patients who did not complete the previous screening round was similar between Child‐Pugh class A (5.4%) and B (7.1%). Moreover, in a previous study, we observed that the absence of previous liver decompensation was associated with suboptimal adherence …”

“…The characteristics of this cohort have recently been reported in two studies, but essentially, they were predominantly men (78%) with alcoholic (55%) or hepatitis C virus (HCV)‐induced cirrhosis (22%) and in Child‐Pugh class A (79%). Patients were censored at the date of HCC diagnosis ( n = 188), the date of progression to Child‐Pugh class C ( n = 44), the date of death ( n = 167), the date of development of a severe comorbidity ( n = 80), the date of inclusion on a waiting list for liver transplantation ( n = 54), the date of last follow‐up visit ( n = 693), or the date of transfer to another center ( n = 16), whichever came first.…”

Poor adherence to hepatocellular carcinoma surveillance: A systematic review and meta‐analysis of a complex issue

“…We reviewed 232 articles which potentially met the inclusion criteria in their entirety. After full article review, 22 articles fulfilled our criteria for inclusion in the systematic review and meta‐analysis (Figure ) …”

“…Although some prospective studies clearly described that no reminders were offered to patients, and some study protocols did not mention any measures to promote HCC surveillance completion, a number of factors may still contribute to higher adherence in a surveillance prospective study. First, patients selected and/or agreed to participate in a prospective study may be higher risk patients and/or more motivated patients, both of which will improve adherence .…”

“…Although some prospective studies clearly described that no reminders were offered to patients, 17,25,31 and some study protocols did not mention any measures to promote HCC surveillance completion, 22 Recognizing that our study contained high heterogeneity as a result of study design, we also analysed the data for only the retrospec- Although imaging with AFP had a higher surveillance rate than imaging only,we feel this may be a spurious result caused by very stringent and complicated surveillance protocols instituted separately from the accepted guidelines. An excellent example is found when reviewing the very high adherence rate in data from Japan; however, the Japanese HCC surveillance protocol is very rigorous and complicated.…”