Intensity of surveillance for hepatocellular carcinoma determines survival in patients at risk in a hepatitis B‐endemic area. Issue 11 (2nd April 2018)

• Record Type: Journal Article
• Authors: Kim, H. Y.; Nam, J. Y.; Lee, J.‐H.; Lee, H. A.; Chang, Y.; Lee, H. Y.; Cho, H.; Lee, D. H.; Cho, Y. Y.; Cho, E. J.; Yu, S. J.; Lee, J. M.; Kim, Y. J.; Yoon, J.‐H.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 47:Issue 11(2018)
• Page Start: 1490
• Page End: 1501
• Publication Date: 2018-04-02
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.14623
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: Data are insufficient regarding the survival benefit of surveillance for hepatocellular carcinoma (HCC). Aim: To investigate the effectiveness of HCC surveillance in a hepatitis B‐endemic population. Methods: This retrospective cohort study included 1402 consecutive patients who were newly diagnosed with HCC between 2005 and 2012 at a single tertiary hospital in Korea. The primary endpoint was overall survival. Lead‐time and length‐time biases were adjusted (sojourn time = 140 days) and sensitivity analyses were performed. Results: The most common aetiology was hepatitis B (80.4%). Cirrhosis was present in 78.2%. HCC was diagnosed during regular surveillance (defined as mean interval of ultrasonography <8 months, n = 834), irregular surveillance (n = 104) or nonsurveillance (n = 464). Patients in the regular surveillance group were diagnosed at earlier stages ([very] early stage, 64.4%) than the irregular surveillance (40.4%) or nonsurveillance (26.9%) groups and had more chance for curative treatments (52.4%) than the irregular surveillance (39.4%) or nonsurveillance (23.3%) groups (all P < 0.001). Mortality risk was significantly lower in the regular surveillance group (adjusted hazard ratio [aHR], 0.69; 95% [CI], 0.57‐0.83) but not in the irregular surveillance group (aHR, 0.94; 95% CI, 0.69‐1.28) compared with the nonsurveillance group after adjusting for confounding factors and lead‐time. When the subjects were restricted to cirrhotic patients or Child‐Pugh class A/B patients, similar results were obtained for mortality risk reduction between groups. Conclusions: HCC surveillance was associated with longer survival owing to earlier diagnosis and curative treatment. Survival advantage was significant with regular surveillance but not with irregular surveillance. Abstract : Linked Content This article is linked to Senussi and Kowdley, and Kim and Lee papers. To view these articles visithttps://doi.org/10.1111/apt.14805 andhttps://doi.org/10.1111/apt.14827 .