title: Rates of surveillance and management of hepatocellular carcinoma in patients evaluated at a liver transplant center.
abstract: OBJECTIVE
  The treatment of choice for HCC with cirrhosis is liver transplantation (LT). We assessed if patients evaluated for hepatocellular carcinoma are being diagnosed by surveillance, the proportion of patients meeting Milan criteria at diagnosis, and rates of liver transplantation.
  
  
  METHODS
  All HCC cases in cirrhotic patients at Duke University Medical Center in the MELD era (Feb 2002-Oct 2008) were identified. Surveillance was defined as an imaging exam for detection of HCC in the 12 months prior to diagnosis of HCC. Logistic regression was used to examine predictors of LT.
  
  
  RESULTS
  There were 319 cases meeting diagnostic criteria for HCC. Only 30.7% were diagnosed by surveillance and 43.7% met Milan criteria at diagnosis. Patients diagnosed by surveillance were more likely to meet Milan criteria and to receive LT (p < 0.0001 for both outcomes). Surveillance was associated with higher rates of LT with an OR 2.6 (95% CI 1.2-5.7, p = 0.02). Patients managed by a hepatologist were more likely to be diagnosed by surveillance (65.9 vs. 19.0%, p < 0.0001). Patients meeting Milan criteria managed by a hepatologist were more likely to receive LT than those referred from other providers (26.4 vs. 8%, p = 0.009).
  
  
  CONCLUSIONS
  A minority of HCC cases in cirrhotic patients were diagnosed by surveillance, and only 12.5% underwent LT. Patients diagnosed by surveillance were more likely to meet Milan criteria and to undergo LT. These findings highlight the need for increased identification of patients with chronic liver disease and for subsequent referral to hepatologists for enrollment in HCC surveillance programs.
authors.affiliation: Duke University Medical Center, Box 3913, Durham, NC 27710, USA. janice.jou@duke.edu
authors.forename: Janice H
authors.initials: JH
authors.lastname: Jou
authors.forename: Po-Hung
authors.initials: PH
authors.lastname: Chen
authors.forename: Alison
authors.initials: A
authors.lastname: Jazwinski
authors.forename: Iliana
authors.initials: I
authors.lastname: Bouneva
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Smith
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Muir
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D019468:Disease Management; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011159:Population Surveillance; D017064:Process Assessment, Health Care; D011787:Quality of Health Care / Q000592:standards; D012189:Retrospective Studies