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. 2024 Feb;22(2):295-304.e2.
doi: 10.1016/j.cgh.2023.08.003. Epub 2023 Aug 12.

Hepatocellular Carcinoma Surveillance Patterns and Outcomes in Patients With Cirrhosis

Darine Daher  1 , Karim Seif El Dahan  1 , Alva Cano  1 , Michael Gonzales  1 , Crystal Ransom  1 , Erik Jaurez  1 , Osiris Carranza  1 , Lisa Quirk  1 , Todd Morgan  1 , Purva Gopal  1 , Madhukar S Patel  2 , Sarah Lieber  1 , Jeremy Louissaint  1 , Thomas G Cotter  1 , Lisa B VanWagner  1 , Ju Dong Yang  3 , Neehar D Parikh  4 , Adam Yopp  2 , Nicole E Rich  1 , Amit G Singal  5
Affiliations

Hepatocellular Carcinoma Surveillance Patterns and Outcomes in Patients With Cirrhosis

Darine Daher et al. Clin Gastroenterol Hepatol. 2024 Feb.

Abstract

Background & aims: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Early Detection; Hepatocellular Carcinoma; Liver Cancer; Screening; Ultrasound.

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Conflict of interest statement

Conflicts of Interest: Amit Singal has served as a consultant or on advisory boards for Genentech, AztraZeneca, Eisai, Exelixis, Bayer, FujiFilm Medical Sciences, Exact Sciences, Roche, Glycotest, Freenome, and GRAIL. Ju Dong Yang has served as a consultant or on advisory boards for AstraZeneca, Eisai, Exact Sciences, Exelixis, Fujifilm Medical Sciences, Merck and Gilead Sciences. Neehar Parikh has served as a consultant or advisory boards for Eisai, Exelixis, Fujifilm Medical Sciences, and Gilead. Lisa VanWagner has served as a consultant for Numares and Novo-Nordisk, receives research grant support from W.L. Gore & Associates, and serves as an expert witness. Nicole Rich has served as consultant or on advisory boards for AstraZeneca.

None of the other authors have any relevant conflicts of interest to disclose.

Figures

Figure 1:
Figure 1:
Distribution of Surveillance Practices by Diagnostic Era
Figure 2.
Figure 2.
Proportions of Early-Stage HCC by Surveillance Type
See this image and copyright information in PMC

Comment in

References

    1. Llovet JM, Kelley RK, Villanueva A, Singal AG, Pikarsky E, Roayaie S, Lencioni R, Koike K, Zucman-Rossi J, Finn RS. Hepatocellular carcinoma. Nature Reviews Disease Primers. 2021;7(1):6. doi: 10.1038/s41572-020-00240-3. - DOI - PubMed
    1. Moon AM, Singal AG, Tapper EB. Contemporary Epidemiology of Chronic Liver Disease and Cirrhosis. Clin Gastroenterol Hepatol. 2020;18(12):2650–66. Epub 20190808. doi: 10.1016/j.cgh.2019.07.060. - DOI - PMC - PubMed
    1. Estes C, Anstee QM, Arias-Loste MT, Bantel H, Bellentani S, Caballeria J, Colombo M, Craxi A, Crespo J, Day CP, Eguchi Y, Geier A, Kondili LA, Kroy DC, Lazarus JV, Loomba R, Manns MP, Marchesini G, Nakajima A, Negro F, Petta S, Ratziu V, Romero-Gomez M, Sanyal A, Schattenberg JM, Tacke F, Tanaka J, Trautwein C, Wei L, Zeuzem S, Razavi H. Modeling NAFLD disease burden in China, France, Germany, Italy, Japan, Spain, United Kingdom, and United States for the period 2016–2030. J Hepatol. 2018;69(4):896–904. Epub 20180608. doi: 10.1016/j.jhep.2018.05.036. - DOI - PubMed
    1. Huang DQ, Singal AG, Kono Y, Tan DJH, El-Serag HB, Loomba R. Changing global epidemiology of liver cancer from 2010 to 2019: NASH is the fastest growing cause of liver cancer. Cell Metab. 2022;34(7):969–77 e2. Epub 20220603. doi: 10.1016/j.cmet.2022.05.003. - DOI - PMC - PubMed
    1. Huang DQ, Tan DJH, Ng CH, Amangurbanova M, Sutter N, Lin Tay PW, Lim WH, Yong JN, Tang A, Syn N, Muthiah MD, Tan EXX, Dave S, Tay B, Majzoub AM, Gerberi D, Kim BK, Loomba R. Hepatocellular Carcinoma Incidence in Alcohol-Associated Cirrhosis: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2023;21(5):1169–77. Epub 20220805. doi: 10.1016/j.cgh.2022.06.032. - DOI - PMC - PubMed

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