Surveillance as Determinant of Long-Term Survival in Non-Transplanted Hepatocellular Carcinoma Patients

Abstract

Purpose: We aimed at assessing the impact of surveillance on long-term survival in HCC patients. Methods: From the ITA.LI.CA database, we selected 1028 cases with long (≥5 years, LS group) and 2721 controls with short-term survival (<5 years, SS group). The association between surveillance and LS was adjusted for confounders by multivariable logistic regression analysis. Survival of surveilled patients was presented both as observed and corrected for the lead-time bias, and the comparison of survival between surveillance and no surveillance groups was also performed after balancing the baseline characteristics with inverse probability weights (IPW). Results: LS patients were more frequently diagnosed under surveillance (p < 0.0001), and had more favorable baseline characteristics. Surveillance was an independent predictor of LS (OR = 1.413, 95% CI 1.195–1.671; p < 0.0001). The observed and the lead-time corrected survival of surveilled patients were significantly longer compared to the survival of not surveilled patients (p < 0.0001 and p = 0.0008, respectively). In IPW adjusted populations, no survival differences were demonstrated between the two groups (p = 0.30). Conclusions: Surveillance, increasing early-stage diagnosis and applicability of curative treatments, is a fundamental determinant of long-term survival in HCC patients. A wide implementation of surveillance programs should be pursued in order to improve HCC patients’ prognosis.

Effect of Hepatocellular Carcinoma Surveillance Programmes on Overall Survival in a Mixed Cirrhotic UK Population: A Prospective, Longitudinal Cohort Study

“…When this bias arises, survival time is inflated, making an intervention appear to have a greater effect than it actually has [16]. Many non-randomised, observational studies have suggested a survival benefit from HCC surveillance [17,18], but did not investigate whether adherence to surveillance is associated with survival benefit. The aims of this study were to estimate the survival of patients diagnosed with HCC who had been entered into a surveillance programme, and to assess the effect of adherence to the programme on outcomes.…”

Characteristics and survival of patients with primary biliary cholangitis and hepatocellular carcinoma

“…In fact, good residual liver function permits to treat unfavorable tumor stages with an upward, more aggressive approach outside pre-determined stage-linked recommendations, eventually leading to improved survival [30][31][32][33] . These findings emphasize once again two concepts: first, the main determinant of survival in patients with HCC is the receipt of treatments with curative intent; second, the association between survival and surveillance is a proxy of a higher eligibility rate to such treatments among patients under surveillance [34] .…”

Transarterial Chemoembolization for Hepatocellular Carcinoma in Clinical Practice: Temporal Trends and Survival Outcomes of an Iterative Treatment

“…In most geographical areas, the annual HCC mortality almost equals its incidence, confirming the high mortality rate of this tumor [5-year survival rate of 12%-14% in the United States and 20% in Italy (4,5)]. Despite efforts to foster surveillance programs, which could allow an earlier diagnosis and increase the percentage of patients amenable to curative treatments (6)(7)(8), HCC is frequently detected at an advanced stage, thus precluding the possibility to deliver curative treatments such as liver transplantation (LT), liver resection (LR), or ablation (ABL) (9).…”