Intensity of surveillance for hepatocellular carcinoma determines survival in patients at risk in a hepatitis B-endemic area

H. Y. Kim, J. Y. Nam, J. H. Lee, H. A. Lee, Y. Chang, H. Y. Lee, H. Cho, D. H. Lee, Y. Y. Cho, E. J. Cho, S. J. Yu, J. M. Lee, Y. J. Kim, J. H. Yoon

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18 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1490-1501
Number of pages12
JournalAlimentary Pharmacology and Therapeutics
Volume47
Issue number11
DOIs
StatePublished - Jun 2018

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