HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: A meta-analysis - PubMed (original) (raw)

Meta-Analysis

. 2022 Jul;77(1):128-139.

doi: 10.1016/j.jhep.2022.01.023. Epub 2022 Feb 6.

Emily Zhang 2, Manasa Narasimman 2, Nicole E Rich 2, Akbar K Waljee 3, Yujin Hoshida 2, Ju Dong Yang 4, Maria Reig 5, Giuseppe Cabibbo 6, Pierre Nahon 7, Neehar D Parikh 3, Jorge A Marrero 8

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Meta-Analysis

HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: A meta-analysis

Amit G Singal et al. J Hepatol. 2022 Jul.

Abstract

Background & aims: There is controversy regarding the overall value of hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis given the lack of data from randomized-controlled trials. To address this issue, we conducted a systematic review and meta-analysis of cohort studies evaluating the benefits and harms of HCC surveillance in patients with cirrhosis.

Methods: We performed a search of the Medline and EMBASE databases and national meeting abstracts from January 2014 through July 2020 for studies reporting early-stage HCC detection, curative treatment receipt, or overall survival, stratified by HCC surveillance status, among patients with cirrhosis. Pooled risk ratios (RRs) and hazard ratios, according to HCC surveillance status, were calculated for each outcome using the DerSimonian and Laird method for random effects models.

Results: We identified 59 studies including 145,396 patients with HCC, which was detected by surveillance in 41,052 (28.2%) cases. HCC surveillance was associated with improved early-stage detection (RR 1.86, 95% CI 1.73-1.98; I2 = 82%), curative treatment receipt (RR 1.83, 95% CI 1.69-1.97; I2 = 75%), and overall survival (hazard ratio 0.67, 95% CI 0.61-0.72; I2 = 78%) after adjusting for lead-time bias; however, there was notable heterogeneity in all pooled estimates. Four studies examined surveillance-related physical harms due to false positive or indeterminate surveillance results, but no studies examined potential financial or psychological harms. The proportion of patients experiencing surveillance-related physical harms ranged from 8.8% to 27.5% across studies, although most harms were mild in severity.

Conclusion: HCC surveillance is associated with improved early detection, curative treatment receipt, and survival in patients with cirrhosis, although there was heterogeneity in pooled estimates. Available data suggest HCC surveillance is of high value in patients with cirrhosis, although continued rigorous studies evaluating benefits and harms are still needed.

Lay summary: There has been ongoing debate about the overall value of hepatocellular carcinoma (HCC) screening in patients with cirrhosis given the lack of data from randomized-controlled trials. In a systematic review of contemporary cohort studies, we found that HCC screening is associated with improved early detection, curative treatment receipt, and survival in patients with cirrhosis, although there were fewer data quantifying potential screening-related harms. Available data suggest HCC screening is of high value in patients with cirrhosis, although continued studies evaluating benefits and harms are still needed.

Keywords: Screening; cirrhosis; early detection; liver cancer; ultrasound.

Copyright © 2022 European Association for the Study of the Liver. All rights reserved.

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Conflict of interest statement

Conflict of Interest Amit Singal has served as a consultant or on advisory boards for Bayer, Wako Diagnostics, Exact Sciences, Roche, Glycotest, and GRAIL. Jorge Marrero has served as a consultant for Glycotest. Neehar Parikh has served as a consultant or on advisory boards for Bayer, Wako Diagnostics, Exact Sciences, Glycotest, and Freenome. Maria Reig has served as consulant or advisory boards for Bayer-Shering Pharma, BMS, Roche, Ipsen, AstraZeneca, Lilly, BTG/Paid conferences: Bayer-Shering Pharma, BMS, Gilead, Lilly and is a principal investigator of research Grants of Bayer-Shering Pharma, Ipsen. Giuseppe Cabibbo has served as a consultant or on advisory boards for Bayer, Eisai, and Ipsen. Ju Dong Yang has served as a consultant or on advisory boards for Exact Sciences and Gilead Sciences and Eisai. None of the other authors have any relevant conflicts of interest. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

Figure 1.

Figure 1.. Association Between HCC Surveillance and Early Tumor Detection

Patients who underwent surveillance were significantly more likely to have HCC diagnosed at an early stage (OR 1.94, 95% CI 1.80 – 2.08); however, there was significant heterogeneity (I2=84%, p<0.001). DerSimonian and Laird method was used for a random effects model.

Figure 2.

Figure 2.. Association Between HCC Surveillance and Curative Treatment Receipt

Patients diagnosed by surveillance were significantly more likely to undergo curative therapy, with a pooled odds ratio of 1.83 (95%CI 1.69 – 1.97), although there was high heterogeneity among studies (I2=75%, p<0.001). DerSimonian and Laird method was used for a random effects model.

Figure 3.

Figure 3.. Association Between HCC Surveillance and Overall Survival

HCC surveillance was significantly associated with improved survival, with a pooled hazard ratio of 0.66 (95%CI 0.61 – 0.71); however, there was high heterogeneity (I2=75%, p<0.001). DerSimonian and Laird method was used for a random effects model.

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References

    1. Moon AM, Singal AG, Tapper EB. Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis. Clin Gastroenterol Hepatol 2020;18:2650–2666. - PMC - PubMed
    1. Llovet JM, Kelley RK, Villanueva A, et al. Singal AG, Pikarsky E, Roayaie S, et al. Hepatocellular carcinoma. Nat Rev Dis Primers 2021;7:6. - PubMed
    1. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis M, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2018;68:723–750. - PubMed
    1. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018;69:182–236. - PubMed
    1. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol 2004;130:417–22. - PubMed

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