Association between ultrasonography screening and mortality in patients with hepatocellular carcinoma: a nationwide cohort study. Issue 4 (10th February 2015)

• Record Type: Journal Article
• Authors: Wu, Chun-Ying; Hsu, Yao-Chun; Ho, Hsiu J; Chen, Yi-Ju; Lee, Teng-Yu; Lin, Jaw-Town
• Is Part Of: Gut. Volume 65:Issue 4(2016)
• Page Start: 693
• Page End: 701
• Publication Date: 2015-02-10
• Subjects: HEPATOCELLULAR CARCINOMA -- ULTRASONOGRAPHY -- SCREENING; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2014-308786
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: Current guidelines recommend screening for hepatocellular carcinoma (HCC) in high-risk populations. However, the effectiveness of screening in reducing mortality has been challenged. In addition, it is unclear which subgroups benefit most from HCC screening. Design: This nationwide cohort study identified a total of 52 823 newly diagnosed HCC patients between 1 January 2002 and 31 December 2007. These HCC patients were classified into the following cohorts according to the time intervals in which they received ultrasonography screening: 0–6 months (6M), 7–12 months (12M), 13–24 months (24M), 25–36 months (36M) and not screened within 3 years (never screened). The chance to receive curative therapy and 5-year cumulative mortalities were calculated after adjusting for lead-time bias. Results: Chances to receive curative therapy among the 6M, 12M, 24M, 36M and never screened cohorts were 24.3% (95% CI 23.7% to –24.9%), 26.9% (95% CI 25.7% to 28.2%), 22.9% (95% CI 21.8% to 24.1%), 21.3% (95% CI 19.9% to 22.8%) and 18.3% (95% CI 17.8% to 18.8%), respectively. Compared with the 6M cohort, adjusted HRs of mortality for the 12M, 24M, 36M and never screened cohorts were 1.11 (95% CI 1.07 to 1.15), 1.23 (95% CI 1.19 to 1.28), 1.31 (95% CI 1.26 to 1.37) and 1.47 (95% CI 1.43 to 1.51) (all p<0.001), respectively. On multivariable subgroup analyses, the associations between shorter screening intervals and better survival were observed in nearly all subgroups, especially in younger patients, patients without diabetes and patients with hepatitis B infection. Conclusions: Shorter ultrasonography screening intervals are associated with reduced overall mortality in HCC patients in a dose-dependent manner.