Hepatocellular Carcinoma Screening Is Associated With Increased Survival of Patients With Cirrhosis

Abstract

Background & Aims: Hepatocellular carcinoma (HCC) screening of patients with cirrhosis is recommended by professional societies to increase detection of early-stage tumors and survival but is underused in clinical practice. Methods: We conducted a retrospective cohort study of 13,714 patients diagnosed with HCC from 2003 through 2013 included in the Surveillance, Epidemiology, and End Results Program-Medicare database. We characterized receipt of HCC screening in the 3 years before HCC diagnosis using mutually exclusive categories (consistent vs inconsistent vs no screening) and proportion of time covered with screening. Correlates for screening receipt were assessed using a multivariable 2-part regression model. We examined the association between screening receipt and early detection of tumors using multivariable logistic regression. We evaluated associations

Hepatocellular carcinoma surveillance, early detection and survival in a privately insured US cohort

“…We also performed sensitivity analysis with adjustment for lead-time bias by assuming sojourns of 3, 6 or 9 months in patients who had PTC below the median. 10 In a secondary analysis, we also performed multivariable logistic regression to define correlates of curative treatment receipt, defined as receiving liver transplantation, surgical resection or local ablation as the first HCC treatment. For this analysis, PTC was the primary independent variable; covariates were age, sex and all other non-redundant factors associated with early-stage diagnosis at P < .10 in univariable analyses.…”

“…In the multivariable Cox model, PTC was the primary independent variable; covariates were age, sex and all other non‐redundant factors associated with mortality at P < .10 in univariable analyses. We also performed sensitivity analysis with adjustment for lead‐time bias by assuming sojourns of 3, 6 or 9 months in patients who had PTC below the median …”

“…Several professional societal guidelines recommend HCC surveillance in at‐risk populations, including those with cirrhosis, using ultrasound (US) with or without alpha‐foetoprotein (AFP) . However, HCC surveillance in patients with cirrhosis does not have level I evidence and has been primarily supported by cohort studies demonstrating an association with earlier stage detection, greater likelihood of receiving curative therapy and improved survival . These studies have notable limitations including potential for lead‐time bias, length time bias and residual confounding .…”

“…[6][7][8] However, HCC surveillance in patients with cirrhosis does not have level I evidence and has been primarily supported by cohort studies demonstrating an association with earlier stage detection, greater likelihood of receiving curative therapy and improved survival. [9][10][11] These studies have notable limitations including potential for leadtime bias, length time bias and residual confounding. 12 It is well recognized that US and AFP can have limited sensitivity for early stage HCC detection in clinical practice, with a recent meta-analysis reporting a sensitivity of only 63% for early-stage HCC detection when using the two tests in combination.…”

Letter: hepatocellular carcinoma surveillance determines survival in patients at risk

“…As in other studies, individuals without surveillance had the highest rate of cirrhosis. 1,2 Results based on total population and those with cirrhosis showed positive findings. However, results only based on individuals without cirrhosis are unknown.…”