Effectiveness of Hepatocellular Carcinoma Surveillance and an Optimal Surveillance Interval: Nationwide Cohort of Korea

Abstract

Purpose To assess associations between surveillance intervals in a national hepatocellular carcinoma (HCC) surveillance program and receiving curative treatment and mortality using nationwide cohort data for Korea. Materials and Methods Using the National Health Insurance Service Database of Korea, we retrospectively identified 3201852 patients, the target population of the national HCC surveillance program, between 2008 and 2017. After exclusion, a total of 64674 HCC patients were divided based on surveillance intervals: never screened, ≤6 months (6M), 7–12 months (1Y), 13–24 months (2Y), and 25–36 months (3Y). Associations for surveillance interval with the chance to receive curative therapy and all-cause mortality were analyzed. Results The 6M group (51.9%) received curative therapy more often than the other groups (1Y, 48.3%; 2Y, 43.8%; 3Y, 41.3%; never screened, 34.5%). Odds ratio for receiving curative therapy among the other surveillance interval groups (1Y, 0.87; 2Y, 0.76; 3Y, 0.77; never screened, 0.57; p <0.001) were significantly lower than that of the 6M group. The hazard ratios (HRs) of all-cause mortality were 1.07, 1.14, and 1.37 for 2Y, 3Y, and never screened groups. The HR for the 1Y group (0.96; p =0.092) was not significantly different, and it was lower (0.91; p <0.001) than that of the 6M group after adjustment for lead-time bias. Curative therapy was associated with survival benefits (HR, 0.26; p <0.001). Conclusion HCC surveillance, especially at a surveillance interval of 6 months, increases the chance to receive curative therapy.

Gaps in hepatocellular carcinoma surveillance among insured patients with hepatitis B infection without cirrhosis in the United States

“…[ 8 ] Unfortunately, HCC surveillance is widely underused, [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ] despite evidence that it can promote early detection and potentially improve survival among patients with chronic HBV. [ 4 , 17 , 18 , 19 , 20 ] In a recent systematic review and meta‐analysis of 22 studies including 19,511 patients with cirrhosis or chronic viral hepatitis, the adherence rate to AASLD surveillance guidelines was only 52% overall and was 39% when limited to retrospective analyses, which may be a better reflection of real‐world practice. [ 21 ] Due in part to such low surveillance rates, most individuals with HCC are diagnosed at an intermediate or advanced stage, when the prognosis is much poorer.…”