Only one-third of hepatocellular carcinoma cases are diagnosed via screening or surveillance: a systematic review and meta-analysis

Abstract

Background/objects Early hepatocellular carcinoma diagnosis is associated with better long-term survival. Studies of at-risk patients who are monitored in routine practice have reported an overall adherence rate to hepatocellular carcinoma screening/surveillance of approximately 60% and suboptimal diagnostic efficacy of the current screening/surveillance tools. However, it is unclear how many hepatocellular carcinoma patients were actually diagnosed via screening/surveillance given these obstacles. Therefore, via a systematic review of PubMed and Scopus databases from 2000 to 2019, we aimed to identify the proportion of patients with hepatocellular carcinoma diagnosed via screening/surveillance in routine practice. Methods We included original research articles of studies of patients already diagnosed with hepatocellular carcinoma that reported the proportion of hepatocellular carcinoma diagnosed via screening/surveillance. Results The study included 60 studies and 50 554 hepatocellular carcinoma cases. The pooled proportion of hepatocellular carcinoma diagnosed by screening/surveillance was 37% (95% confidence interval: 31%–44%) and differed by geographic region (North America/Asia/Europe/Oceania/Africa/South America, 31%/42%/41%/30%/29%/47%, P = 0.017, respectively) and by surveillance interval (<12 months 39% vs. 12 months 19%, P < 0.01) but not by disease etiology, cirrhosis status, clinical setting, practice setting, hepatocellular carcinoma diagnosis period, or surveillance method. Conclusion Globally, hepatocellular carcinoma was diagnosed via screening/surveillance in less than half of the patients (37%) regardless of healthcare setting or liver disease etiology and without improvement over time despite several recent guideline updates. Research is needed to understand the barriers to screening/surveillance to include medical as well as social and cultural influences.

Review article: current gaps and opportunities in HBV prevention, testing and linkage to care in the United States—a call for action

“…Particularly, in patients with CHB, the pooled adherence rate for HCC surveillance was only 32% (95% CI 13%‐51%) which is consistent globally and in both cirrhotic (36%) and non‐cirrhotic (22%) 121 . (Table 3) As a result, only about one‐third of HCC were diagnosed at pre‐symptomatic stage globally, according to meta‐analysed data from 5875 viral hepatitis‐related HCC cases 119 …”

“…A previous study from a tertiary centre in Northern California showed that 22.1% of HCC were HBV‐related 116 . Therefore, major guidelines recommend HCC surveillance via ultrasound with or without AFP every 6 months among high‐risk individuals (ie cirrhosis from any etiologies and high‐risk patients with CHB) so that HCC can be identified in its earliest stages to allow for curative therapy and improved survival 28,117‐119 …”

Does Hepatocellular Carcinoma Surveillance Increase Survival in At-Risk Populations? Patient Selection, Biomarkers, and Barriers

“…Globally, only 37% of HCC is diagnosed through surveillance, with < 20% of patients undergoing surveillance per recommended guidelines in USA [61,62]. Barriers include patient, clinician, and health system factors (Fig.…”

Hepatocellular carcinoma surveillance in Australia: time to improve the diagnosis of cirrhosis and use liver ultrasound

“…Most models include a clinical coordinator and, depending on the location of the patient group, may be based at a tertiary centre, in primary care or in other facilities accessible and appropriate for patients . Adherence rates in patients may be improved using memory triggers, linguistic aids and reminder systems for both patients and providers . A cost‐effectiveness clinical trial of such a model is currently underway and will report its outcomes in 2021 (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372421).…”