Hepatocellular Carcinoma Surveillance Patterns and Outcomes in Patients With Cirrhosis

Hepatocellular Carcinoma Surveillance Patterns and Outcomes in Patients With Cirrhosis

Hepatocellular carcinoma (HCC) surveillance is associated with improved early detection and reduced mortality, although practice patterns and effectiveness vary in clinical practice. We aimed to characterize HCC surveillance patterns in a large, diverse cohort of patients with HCC. We conducted a re...

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Published in:Clinical gastroenterology and hepatology Vol. 22; no. 2; pp. 295 - 304.e2
Main Authors: Daher, Darine, Seif El Dahan, Karim, Cano, Alva, Gonzales, Michael, Ransom, Crystal, Jaurez, Erik, Carranza, Osiris, Quirk, Lisa, Morgan, Todd, Gopal, Purva, Patel, Madhukar S, Lieber, Sarah, Louissaint, Jeremy, Cotter, Thomas G, VanWagner, Lisa B, Yang, Ju Dong, Parikh, Neehar D, Yopp, Adam, Rich, Nicole E, Singal, Amit G
Format: Journal Article
Language:English
Published: United States 01-02-2024
Subjects:
alpha-Fetoproteins - analysis
Carcinoma, Hepatocellular - diagnosis
Carcinoma, Hepatocellular - epidemiology
Carcinoma, Hepatocellular - therapy
Humans
Liver Cirrhosis - pathology
Liver Neoplasms - diagnosis
Liver Neoplasms - epidemiology
Liver Neoplasms - therapy
Retrospective Studies
Ultrasonography
Early Detection
Screening
Liver Cancer
Ultrasound
Hepatocellular Carcinoma
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Summary:Hepatocellular carcinoma (HCC) surveillance is associated with improved early detection and reduced mortality, although practice patterns and effectiveness vary in clinical practice. We aimed to characterize HCC surveillance patterns in a large, diverse cohort of patients with HCC. We conducted a retrospective cohort study of patients diagnosed with HCC between January 2008 and December 2022 at 2 large US health systems. We recorded imaging receipt in the year before HCC diagnosis: ultrasound plus α-fetoprotein (AFP), ultrasound alone, multiphasic contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI), and no liver imaging. We used multivariable logistic and Cox regression analysis to compare early tumor detection, curative treatment receipt, and overall survival between surveillance strategies. Among 2028 patients with HCC (46.7% Barcelona Clinic Liver Cancer stage A), 703 (34.7%) had ultrasound plus AFP, 293 (14.5%) had ultrasound alone, 326 (16.1%) had multiphasic CT/MRI, and 706 (34.8%) had no imaging in the year before HCC diagnosis. Over the study period, proportions without imaging were stable, whereas use of CT/MRI increased. Compared with no imaging, CT/MRI and ultrasound plus AFP, but not ultrasound alone, were associated with early stage HCC detection and curative treatment. Compared with ultrasound alone, CT/MRI and ultrasound plus AFP were associated with increased early stage detection. HCC surveillance patterns vary in clinical practice and are associated with differing clinical outcomes. While awaiting data to determine if CT or MRI surveillance can be performed in a cost-effective manner in selected patients, AFP has a complementary role to ultrasound-based surveillance, supporting its adoption in practice guidelines.
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ISSN:1542-3565
1542-7714
1542-7714
DOI:10.1016/j.cgh.2023.08.003