Effectiveness of surveillance for hepatocellular carcinoma in clinical practice: A United States cohort - PubMed (original) (raw)

Effectiveness of surveillance for hepatocellular carcinoma in clinical practice: A United States cohort

Sahil Mittal et al. J Hepatol. 2016 Dec.

Abstract

Background & aims: The effectiveness of surveillance for hepatocellular carcinoma (HCC) in reducing cancer related mortality among patients with cirrhosis is largely unknown. The objective of this study was to study the effectiveness of HCC surveillance in the national Veterans Administration (VA) clinical practice.

Methods: We conducted a retrospective cohort study of patients with HCC during 2005-2010 by reviewing patients' medical records to determine receipt of HCC surveillance in the 2years prior to HCC diagnosis. We determined association of HCC surveillance with overall mortality adjusting for age, risk factors, model for end-stage liver disease (MELD) score, comorbidity index, alpha-fetoprotein levels, healthcare utilization, Barcelona Clinic Liver Cancer (BCLC) stage, and treatment. We accounted for lead and length time biases.

Results: Of 887 patients with HCC, only 412 (46.5%) received any surveillance prior to HCC diagnosis. Patients who received surveillance were significantly more likely to have early stage disease HCC (BCLC stage 0/A 27.2% vs. 11.6%) and receive potentially curative (20.9% vs. 11.6%) or palliative (59.2% vs. 45.5%) treatments compared to those without HCC surveillance. Receipt of HCC surveillance was associated with 38% reduction in mortality risk (unadjusted hazard ratios (HR) 0.62, 95% confidence intervals (CI) 0.54-0.71) that declined to 20% (HR 0.80, 95% CI 0.69-0.94) after adjusting for HCC stage and treatment, compared to those without HCC surveillance.

Conclusions: Among patients with HCC, pre-diagnosis HCC surveillance is associated with a significant 38% reduction in overall mortality. The reduction in mortality risk with surveillance is mediated via stage migration and receipt of HCC specific treatment.

Lay summary: Surveillance for liver cancer leads to earlier detection of cancer and increases chances of getting curative treatment. This ultimately leads to increased longevity in patients with liver cancer.

Keywords: Cirrhosis; Fatty liver; Lead-time; Liver cancer; Screening.

Copyright © 2016 European Association for the Study of the Liver. All rights reserved.

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Conflict of interest statement

Conflicts of Interest: No conflicts of interest exist for Drs. Mittal, Sada, El-Serag, Kanwal, Ms. Temple, Ms. May, Kramer, Richardson, and Davila.

Figures

Figure 1

Figure 1

Kaplan Meier showing survival probability in months following HCC diagnosis stratified by surveillance category after adjustment for a presumed lead time of 100 days. Patients were censored for death due to any reason or lost to follow up.

References

    1. Mittal S, El-Serag HB. Epidemiology of hepatocellular carcinoma: Consider the population. J Clin Gastroenterol. 2013;47(Suppl):S2–S6. - PMC - PubMed
    1. El-Serag Hepatocellular carcinoma. N Engl J Med. 2011 Sep 22;365(12):1118–1127. - PubMed
    1. El-Serag HB, Marrero JA, Rudolph L, et al. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology. 2008;134:1752–1763. - PubMed
    1. Bruix J, Sherman M American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–1022. - PMC - PubMed
    1. Ferenci P, Fried M, Labrecque D, Bruix J, Sherman M, Omata M, et al. World Gastroenterology Organisation Guidelines and Publications Committee. World Gastroenterology Organisation Guideline. Hepatocellular carcinoma (HCC): a global perspective. J Gastrointestin Liver Dis. 2010;19:311–317. - PubMed

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