Surveillance Rate and its Impact on Survival of Hepatocellular Carcinoma Patients in South Korea: A Cohort Study

Abstract

PurposeThough regular surveillance of hepatocellular carcinoma (HCC) for high-risk patients is widely recommended, its rate and effectiveness are not clear. The aim of this study is to investigate the actual rate of HCC surveillance and its related factors and to clarify its impact on survival in a Korean HCC cohort.Materials and MethodsFrom 2012 to 2015, 319 newly diagnosed HCC patients were prospectively enrolled at a tertiary hospital. Patient interviews based on a structured questionnaire survey were conducted. Surveillance was defined as liver imaging test ≥ 2 times with at least 3-month interval within 2 years prior to HCC diagnosis.ResultsSurveillance rate was 39.8%. Of the HCC patients with high-risk factors, only 182 (57.1%) had knowledge for the need for regular surveillance, and 141 (44.2%) had the accurate information about the method (ultrasound-based study). Surveillance group showed a higher proportion of early HCC (p < 0.001) and a longer overall survival (p < 0.001) compared to non-surveillance group. The multivariable Cox regression analysis indicated Child-Pugh class A, history of anti-viral therapy, low serum α-fetoprotein level, non-advanced Barcelona Clinic Liver Cancer stage as independent predictors of overall survival, while regular surveillance was not (p=0.436).ConclusionLess than half of the newly diagnosed Korean HCC patients were under surveillance and the accurate perception for the need of HCC surveillance was insufficient. Of those under surveillance, most patients were diagnosed with early stage HCC, which led to the improved survival. Comprehensive efforts to optimize the surveillance program for the target population are warranted.

Factors that Affect the Surveillance and Late-Stage Detection of a Newly Diagnosed Hepatocellular Carcinoma

“…The main findings of our study were as follows. First, one-half of newly diagnosed patients were aware of their diagnosis of being at risk of HCC, and only one-third adhered to regular HCC The beneficial effects of HCC surveillance have been established in early detection, in enhancing patients receiving curative therapies, and possibly in improving overall survival (Ahmad et al, (2020); Im et al, 2019;Stravitz et al, 2008;Yang et al, 2011). A major step for ameliorating the adherence to HCC is identifying which patients are at risk of developing HCC.…”

“…Chonprasertsuk and Vilaichone (2017) demonstrated that HCC patients usually present with an advanced stage of HCC because they were unaware of their risks. HCC surveillance has been proven to increase earlystage diagnosis and the assessment of curative therapy, and improve survival (Im et al, 2019;Stravitz et al, 2008;Yang et al, 2011). Our results generally agree with these findings, including regular HCC surveillance as an independent preventive factor of detecting a late-stage tumor at the time of diagnosis.…”

“…HCC surveillance (using regular hepatic US with/ without AFP) increases the rate of detecting early-stage HCC, thereby resulting in patients receiving curative treatment and possibly improving survival outcomes (Im et al, 2019;Stravitz et al, 2008;Yang et al, 2011). Despite these well-known beneficial effects, the adoption of HCC surveillance in clinical practice remains suboptimal and accounts for 20%-70%; this varies among countries (Francica and Borzio, 2019;Singal et al, 2012).…”

Prior antiviral treatment and mortality among patients with hepatitis C virus-related hepatocellular carcinoma: A national cohort study

“…It is possible that those who received antiviral treatment were more likely to engage in care and receiving HCC surveillance. They would be more likely to be diagnosed at early-stage HCC, and had improved survival [ 33 ]. However, due to the nature of the claim data, we were not able to include information on HCC surveillance.…”

Ramucirumab as a second-line treatment for hepatocellular carcinoma: reaching out further to patients with elevated alpha-fetoprotein

“…Surveillance for HCC is recommended by all liver disease associations, as it increases patient survival mainly as a result of early diagnosis of the tumour, allowing most patients to convey to curative treatments (2,3). However, the actual uptake of surveillance for HCC in clinical practice is low, so that a large proportion of patients are diagnosed with HCC at an advanced disease stage (4,5). Moreover, HCC often recurs even after curative treatments or progresses to more advanced stages after non-curative treatments, making the therapeutic decision for this cancer a complex, dynamic and step-by-step process (6).…”