Hepatocellular Carcinoma Surveillance: Are We Utilizing It?

Abstract

Background and goals: International guidelines recommend 6-monthly ultrasound scan surveillance in cirrhotic patients for hepatocellular carcinoma (HCC) screening. The aim of this study was to evaluate HCC surveillance and to provide the outcomes for the largest reported cirrhosis cohort in the United Kingdom.

Study: We retrospectively reviewed all cirrhotic patients during the 6 months before April 1, 2014 at 3 teaching hospitals within the Imperial College Healthcare NHS Trust. All patients with cirrhosis eligible for HCC screening in the cohort were reviewed for evidence of screening and were characterized as either "routine" or "overdue." Reasons for failure to meet guidelines were identified in overdue patients. Univariate analyses were conducted to determine clinical and sociodemographic predictors of surveillance with a view to performing multivariate analysis.

Results: Of the 898 patients eligible for inclusion, 65% patients had HCC surveillance performed in the past 6 months. During the observation period, 61 (6.8%) cases of HCC were detected. Thirty-eight were picked up on surveillance, 9 incidentally and in 14 cases it could not be determined from the notes. Within this cohort HCCs diagnosed on surveillance did not demonstrate significantly superior outcomes compared with those picked up incidentally.

Conclusions: Surveillance of patients with cirrhosis within this cohort is suboptimal. Although disappointing at a local level, this is likely to be reflective of practice elsewhere.