Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival Among Patients with Cirrhosis in the US - 23/08/17
, Sahil Mittal, MD d, Olutola A. Yerokun, BS a, Chul Ahn, PhD b, Jorge A. Marrero, MD, MS a, Adam C. Yopp, MD e, Neehar D. Parikh, MD, MS f, Steve J. Scaglione, MD gAbstract |
Background |
Professional societies recommend hepatocellular carcinoma screening in patients with cirrhosis, but high-quality data evaluating its effectiveness to improve early tumor detection and survival in “real world” clinical practice are needed. We aim to characterize the association between hepatocellular carcinoma screening and early tumor detection, curative treatment, and overall survival among patients with cirrhosis.
Methods |
We performed a retrospective cohort study of patients diagnosed with hepatocellular carcinoma between June 2012 and May 2013 at 4 health systems in the US. Patients were categorized in the screening group if hepatocellular carcinoma was detected by imaging performed for screening purposes. Generalized linear models and multivariate Cox regression with frailty adjustment were used to compare early detection, curative treatment, and survival between screen-detected and non-screen-detected patients.
Results |
Among 374 hepatocellular carcinoma patients, 42% (n = 157) were detected by screening. Screen-detected patients had a significantly higher proportion of early tumors (Barcelona Clinic Liver Cancer stage A 63.1% vs 36.4%, P <.001) and were more likely to undergo curative treatment (31% vs 13%, P = .02). Hepatocellular carcinoma screening was significantly associated with improved survival in multivariate analysis (hazards ratio 0.41; 95% confidence interval, 0.26-0.65) after adjusting for patient demographics, Child-Pugh class, and performance status. Median survival of screen-detected patients was 14.6 months, compared with 6.0 months for non-screen-detected patients, with the difference remaining significant after adjusting for lead-time bias (hazards ratio 0.59, 95% confidence interval, 0.37-0.93).
Conclusion |
Hepatocellular carcinoma screening is associated with increased early tumor detection and improved survival; however, a minority of hepatocellular carcinoma patients are detected by screening. Interventions to increase screening use in patients with cirrhosis may help curb hepatocellular carcinoma mortality rates.
Le texte complet de cet article est disponible en PDF.Keywords : Cirrhosis, Liver cancer, Screening
Plan
| Funding: AGS and CA were supported in part by the Agency for Healthcare Research and Quality (AHRQ) Grant R24 HS022418 and National Institutes of Health (NIH)/National Cancer Institute Cancer Center Support Grant P30 CA142543 to the Harold C. Simmons Comprehensive Cancer Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or AHRQ. |
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| Conflict of Interest: None of the authors have any conflicts of interest to declare. |
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| Authorship: AGS: study concept and design, acquisition of data, analysis and interpretation of the data, drafting of the manuscript, critical revision of the manuscript for intellectual content, obtained funding, and study supervision; SM: study concept and design, acquisition of data, analysis and interpretation of the data, critical revision of the manuscript for intellectual content; OAY: acquisition of data, critical revision of the manuscript for intellectual content; CA: analysis of the data and critical revision of the manuscript for intellectual content; JM: critical revision of the manuscript for intellectual content; AY: critical revision of the manuscript for intellectual content; NDP: study concept and design, acquisition of data, analysis and interpretation of the data, critical revision of the manuscript for intellectual content; SJS: study concept and design, acquisition of data, analysis and interpretation of the data, critical revision of the manuscript for intellectual content. |
Vol 130 - N° 9
P. 1099 - septembre 2017 Retour au numéro
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