Surveillance for hepatocellular carcinoma is associated with increased survival: Results from a large cohort in the Netherlands - PubMed (original) (raw)
. 2015 Nov;63(5):1156-63.
doi: 10.1016/j.jhep.2015.06.012. Epub 2015 Jun 20.
Affiliations
- PMID: 26100498
- DOI: 10.1016/j.jhep.2015.06.012
Surveillance for hepatocellular carcinoma is associated with increased survival: Results from a large cohort in the Netherlands
Suzanne van Meer et al. J Hepatol. 2015 Nov.
Abstract
Background & aims: Effectiveness of surveillance for hepatocellular carcinoma is controversial. We here explore its effects in "real life" clinical practice.
Methods: Patients with hepatocellular carcinoma diagnosed in the period 2005-2012 in five Dutch academic centers were evaluated. Surveillance was defined as ⩾2 screening tests during three preceding years and at least one radiologic imaging test within 18 months before diagnosis.
Results: 295 (27%) of 1074 cases underwent surveillance. Median time interval between last negative radiologic imaging and hepatocellular carcinoma diagnosis was 7.5 months. In the surveillance group, cirrhosis (97% vs. 60%, p<0.001) and viral hepatitis were more frequent, and non-alcoholic fatty liver disease or absence of risk factors less frequent. In case of surveillance, tumor size was significantly smaller (2.7 vs. 6.0 cm), with lower alpha-fetoprotein levels (16 vs. 44 μg/L), earlier tumor stage (BCLC 0 and A combined: 61% vs. 21%) and resection/transplantation (34% vs. 25%) or radiofrequency ablation (23% vs. 7%) more often applied, with significantly higher 1-, 3-, and 5-year survival rates. Survival benefit by surveillance remained significant after adjustment for lead-time bias based on assumed tumor doubling time of 90 days, but not with doubling time of ⩾120 days. In multivariate analysis, surveillance was an independent predictor for mortality (for interval ⩽9 respectively >9 months: adjusted HRs 0.51 and 0.50, 95% confidence intervals: 0.39-0.67 and 0.37-0.69).
Conclusions: 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.
Keywords: Hepatocellular carcinoma; Surveillance; Survival.
Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Comment in
- Surveillance for hepatocellular carcinoma: A tale of two countries.
Farrell C, Cross TJ. Farrell C, et al. J Hepatol. 2016 Mar;64(3):754-5. doi: 10.1016/j.jhep.2015.11.041. Epub 2015 Dec 21. J Hepatol. 2016. PMID: 26719021 No abstract available. - Reply to "Surveillance for hepatocellular carcinoma: A tale of two countries".
van Meer S, de Man RA, van Erpecum KJ. van Meer S, et al. J Hepatol. 2016 Mar;64(3):755-6. doi: 10.1016/j.jhep.2015.12.009. Epub 2015 Dec 23. J Hepatol. 2016. PMID: 26721605 No abstract available. - Patients' misconceptions about surveillance for hepatocellular carcinoma: Education is needed.
van Meer S, Lieveld FI, van Erpecum KJ. van Meer S, et al. J Hepatol. 2016 Sep;65(3):653-4. doi: 10.1016/j.jhep.2016.06.012. Epub 2016 Jun 16. J Hepatol. 2016. PMID: 27320363 No abstract available.
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