Trends and patterns of utilization in post-treatment surveillance imaging among patients treated for hepatocellular carcinoma.
BACKGROUND
Little is known about the patterns of utilization of surveillance imaging after treatment of hepatocellular carcinoma (HCC). We sought to define population-based patterns of surveillance and investigate if intensity of surveillance impacted outcome following HCC treatment.


METHODS
The Surveillance, Epidemiology, and End Results-Medicare database was used to identify patients with HCC diagnosed between 1998 and 2007 who underwent resection, ablation, or intra-arterial therapy (IAT). The association between imaging frequency and long-term survival was analyzed.


RESULTS
Of the 1,467 patients, most underwent ablation only (41.5%), while fewer underwent liver resection only (29.6 %) or IAT only (18.3%). Most patients had at least one CT scan (92.7%) during follow-up, while fewer had an MRI (34.1%). A temporal trend was noted with more frequent surveillance imaging obtained in post-treatment year 1 (2.5 scans/year) vs. year 5 (0.9 scans/year; P = 0.01); 34.5% of alive patients had no imaging after 2 years. Frequency of surveillance imaging correlated with procedure type (total number of scans/5 years, resection, 4.7; ablation, 4.9; IAT, 3.7; P < 0.001). Frequency of surveillance imaging was not associated with a survival benefit (three to four scans/year, 49.5 months vs. two scans/year, 71.7 months vs. one scan/year, 67.6 months; P = 0.01) CONCLUSION: Marked heterogeneity exists in how often surveillance imaging is obtained following treatment of HCC. Higher intensity imaging does not confer a survival benefit.
Department of Surgery, Johns Hopkins University School of Medicine, Blalock 688 600N. Wolfe Street, Baltimore, MD 21287, USA.
Omar
O
Hyder
Department of Surgery, Johns Hopkins University School of Medicine, Blalock 688 600N. Wolfe Street, Baltimore, MD 21287, USA.
Rebecca M
RM
Dodson
Department of Surgery, Johns Hopkins University School of Medicine, Blalock 688 600N. Wolfe Street, Baltimore, MD 21287, USA.
Matthew
M
Weiss
Department of Medical Oncology, Johns Hopkins University School of Medicine, Blalock 688 600N. Wolfe Street, Baltimore, MD 21287, USA.
David P
DP
Cosgrove
Department of Radiation Oncology, Johns Hopkins University School of Medicine, Blalock 688 600N. Wolfe Street, Baltimore, MD, USA.
Joseph M
JM
Herman
Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Blalock 688 600N. Wolfe Street, Baltimore, MD, USA.
Jean-Francois H
JH
Geschwind
Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Blalock 688 600N. Wolfe Street, Baltimore, MD, USA.
Ihab R
IR
Kamel
Department of Surgery, Johns Hopkins University School of Medicine, Blalock 688 600N. Wolfe Street, Baltimore, MD 21287, USA.
Timothy M
TM
Pawlik
D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed