Surveillance for hepatocellular carcinoma is associated with increased survival: Results from a large cohort in the Netherlands

Meer, Skadi van der; Man, Robert A. de; Coenraad, Minneke J.; Sprengers, Dave; Nieuwkerk, Karin M.J. van; Klümpen, Heinz‐Josef; Jansen, Petér L. M.; IJzermans, Jan N.M.; Oijen, Martijn G.H. van; Siersema, Peter D.; Erpecum, Karel J. van

doi:10.1016/j.jhep.2015.06.012

Cited by 124 publications

(91 citation statements)

References 45 publications

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“…Liver disease societies worldwide recommend HCC screening in cirrhosis using biannual abdominal ultrasound, 1, 2, 3, 4 which has been associated with early tumor detection, increased curative treatment receipt, and improved overall survival. 5, 6 Although biannual ultrasound for all cirrhotic patients is cost-effective compared with no screening, ultrasound can miss one-third of early-stage HCC due to its suboptimal sensitivity. 7, 8, 9 Other imaging modalities with higher sensitivity for early tumor detection, such as dynamic contrast-enhanced magnetic resonance imging (MRI), have not been recommended as alternatives given its higher cost.…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Risk Score–Stratified Hepatocellular Carcinoma Screening in Patients with Cirrhosis

Goossens

Singal

King

et al. 2017

Clinical and Translational Gastroenterology

139

124

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Objectives:Hepatocellular carcinoma (HCC) surveillance with biannual ultrasound is currently recommended for all patients with cirrhosis. However, clinical implementation of this “one-size-fits-all” approach is challenging as evidenced by its low application rate. We aimed to evaluate the cost-effectiveness of risk-stratified HCC surveillance strategies in patients with cirrhosis.Methods:A Markov decision-analytic modeling was performed to simulate a cohort of 50-year-old subjects with compensated cirrhosis. Risk-stratified HCC surveillance strategies was implemented, in which patients were stratified into high-, intermediate-, or low-risk groups by HCC risk biomarker–based scores and assigned to surveillance modalities tailored to HCC risk (2 non-risk-stratified and 14 risk-stratified strategies) and compared with non-stratified biannual ultrasound.Results:Quality-adjusted life expectancy gains for biannual ultrasound in all patients and risk-stratified strategies compared with no surveillance were 1.3 and 0.9–2.1 years, respectively. Compared with the current standard of biannual ultrasound in all cirrhosis patients, risk-stratified strategies applying magnetic resonance imaging (MRI) and/or ultrasound only in high- and intermediate-risk patients, without screening in low-risk patients, were cost-effective. Abbreviated MRI (AMRI) for high- and intermediate-risk patients had the lowest incremental cost-effectiveness ratio (ICER) of $2,100 per quality-adjusted life year gained. AMRI in intermediate- and high-risk patients had ICERs <$3,000 across a wide range of HCC incidences.Conclusions:Risk-stratified HCC surveillance strategies targeting high- and intermediate-risk patients with cirrhosis are cost-effective and outperform the currently recommended non-stratified biannual ultrasound in all patients with cirrhosis.

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Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness of Risk Score–Stratified Hepatocellular Carcinoma Screening in Patients with Cirrhosis

Goossens

Singal

King

et al. 2017

Clinical and Translational Gastroenterology

139

124

View full text Add to dashboard Cite

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“…While liver ultrasonography (US) is well accepted as an effective modality for screening for HCC, the use of AFP has been less well accepted, and there has been strong judgment expressed by some experts against the use of serum AFP test as a screening biomarker for HCC [4]. On the other, hand, surveys of practicing hepatologists suggest that the majority of hepatologists in Asia, Europe and North America routinely use AFP as a screening test, typically in combination with US [5–8]. Further, Japan and Taiwan, countries that have documented the best long-term outcomes for HCC through nationwide surveillance programs apply a combination of US, AFP, as well as other biomarkers (Lens culinaris binding AFP (AFP-L3%) and des gamma carboxy prothrombin (DCP)) [9, 10].…”

Section: Introductionmentioning

confidence: 99%

“…For many clinicians, these factors appear to justify use of US and AFP in combination for surveillance for HCC. After a number of years in which the primary debates about HCC surveillance were anchored around the perceived flaws in the supporting literature, such as lack of adjustment for lead time and length time bias, we are beginning to see results of a number of studies from Asia, North America and Europe that are addressing these concerns and providing more robust confirmation of surveillance benefits [19–25, 8, 26]. In addition, recent advances in next generation sequencing and molecular analysis of tumors, blood, stool and other analytes are producing what potentially may prove to be very exciting breakthroughs in biomarker technology, particularly assays of differentially methylated DNA regions and microRNAs.…”

Section: Introductionmentioning

confidence: 99%

Should AFP (or Any Biomarkers) Be Used for HCC Surveillance?

Mohammed

Roberts

2017

Curr Hepatology Rep

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a) Purpose of review To address the controversy around the use of biomarkers for hepatocellular carcinoma (HCC) surveillance in individuals with cirrhosis or chronic hepatitis B who are at risk for development of liver cancer. b) Recent findings Recent studies suggest that surveillance for hepatocellular carcinoma is beneficial, even after adjustment for lead time and other biases. Alpha fetoprotein (AFP) is complementary to ultrasound (US) in surveillance, particularly in obese patients and patients with infiltrative tumors. US and AFP are both associated with harms to patients from false positive over-diagnosis, with US appearing to cause greater harms. Including patient demographic characteristics and additional biomarkers into diagnostic models is beneficial. Recent studies emphasize the advantage of time trends in biomarkers over single cross-sectional measurements. c) Summary AFP and other biomarkers are complementary to US in surveillance for HCC, especially when applied in models including patient variables and incorporating time trends in biomarker levels. With advances in genetic and molecular analysis of tumors, we may be poised at the cusp of a revolution in HCC surveillance.

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“…This poor adherence to HCC surveillance leads to detection at advanced stages, drastically lowering OS. [6]…”

Section: Introductionmentioning

confidence: 99%

Oral Medications Enhance Adherence to Surveillance for Hepatocellular Carcinoma and Survival in Chronic Hepatitis B Patients

et al. 2017

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Background/AimsRegular surveillance for hepatocellular carcinoma (HCC) in chronic hepatitis B (CHB) patients is essential to detect HCC earlier and to improve prognosis. This study investigated whether prescription of oral medication contributes to adherence to surveillance, early tumor detection, and overall survival (OS).MethodsA total of 401 CHB patients who were newly diagnosed with HCC were included: 134 patients received no medication (group 1), 151 received hepatoprotective agents such as ursodeoxycholic acid and silymarin (group 2), and 116 received antiviral agents (group 3) at two years before HCC diagnosis. The primary endpoint was OS, and secondary endpoints were compliance to regular surveillance and HCC status at diagnosis.ResultsCompared to group 1, both group 2 and 3 had higher rates of good compliance to regular surveillance (defined as participation in >80% of imaging intervals being ≤6 months) (58.2%, 90.1%, and 97.4%, respectively; P<0.001), more HCC diagnosed at a very early stage (20.9%, 32.5%, and 36.2%; P = 0.019) and smaller tumor size (2.8±2.4cm, 1.9±1.1cm, and 1.8±0.9cm; P<0.001). Finally, compared to group 1, both group 2 (hazard ratio, 0.63; 95% confidence interval, 0.41–0.97; P = 0.035) and group 3 (hazard ratio, 0.40; 95% confidence interval, 0.22–0.71; P = 0.002) had significantly longer OS. In mediation analysis, prolonged OS is resulted considerably from indirect effect mediated by shorter imaging interval (>100% in group 2 and 14.5% in group 3) rather than direct effect of medication itself.ConclusionsPrescription of oral medication improves compliance to surveillance and enables early detection of HCC, which is associated with enhanced survival.

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Surveillance for hepatocellular carcinoma is associated with increased survival: Results from a large cohort in the Netherlands

Abstract: Surveillance for hepatocellular carcinoma was associated with smaller tumor size, earlier tumor stage, with an impact on therapeutic strategy and was an independent predictor of survival.

Cited by 124 publications

References 45 publications

Cost-Effectiveness of Risk Score–Stratified Hepatocellular Carcinoma Screening in Patients with Cirrhosis

Cost-Effectiveness of Risk Score–Stratified Hepatocellular Carcinoma Screening in Patients with Cirrhosis

Should AFP (or Any Biomarkers) Be Used for HCC Surveillance?

Oral Medications Enhance Adherence to Surveillance for Hepatocellular Carcinoma and Survival in Chronic Hepatitis B Patients

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