title: Hepatocellular carcinoma screening in patients with compensated hepatitis C virus (HCV)-related cirrhosis aware of their HCV status improves survival: a modeling approach.
abstract: Because of the ongoing debate on the benefit of ultrasound (US) screening for hepatocellular carcinoma (HCC), we assessed the impact of screening on hepatitis C virus (HCV)-related compensated cirrhosis patients aware of their HCV status. A Markov model simulated progression from HCC diagnosis to death in 700 patients with HCV-related compensated cirrhosis aware of their HCV status to estimate life expectancy (LE) and cumulative death at 5 years. Five scenarios were compared: S1, no screening; S2, screening by currently existing practices (57% access and effectiveness leading to the diagnosis of 42% at Barcelona Clinic Liver Cancer stage [BCLC-0/A]); S3, S2 with increased access (97%); S4, S2 with an efficacy of screening close to that achieved in a randomized controlled trial leading to the diagnosis of 87% of patients at stage BCLC-0/A; S5, S3+S4. The analysis was corrected for lead-time bias. Currently existing practices of HCC screening increased LE by 11 months and reduced HCC mortality at 5 years by 6% compared to no screening (P = 0.0013). Compared to current screening practices, we found that: 1) increasing the rate of access to screening would increase LE by 7 months and reduce HCC mortality at 5 years by 5% (P = 0.045); 2) optimal screening would increase LE by 14 months and reduce HCC mortality at 5 years by 9% (P = 0.0002); 3) the combination of an increased rate of access and optimal effectiveness of HCC screening would increase LE by 31 months and decrease HCC mortality at 5 years by 20% (P < 0.0001).
  
  
  CONCLUSIONS
  The present study shows that US screening for HCC in patients with compensated HCV-related cirrhosis aware of their HCV status improves survival and emphasizes the crucial role of screening effectiveness.
authors.affiliation: Inserm U995, Université Lille Nord de France, Lille, France; IAME, UMR 1137, Inserm, Paris, France, Univ. Paris Nord Sorbonne Paris Cité, Paris, France.
authors.forename: Abbas
authors.initials: A
authors.lastname: Mourad
authors.forename: Sylvie
authors.initials: S
authors.lastname: Deuffic-Burban
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ganne-Carrié
authors.forename: Thibaud
authors.initials: T
authors.lastname: Renaut-Vantroys
authors.forename: Isabelle
authors.initials: I
authors.lastname: Rosa
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Bouvier
authors.forename: Guy
authors.initials: G
authors.lastname: Launoy
authors.forename: Stephane
authors.initials: S
authors.lastname: Cattan
authors.forename: Alexandre
authors.initials: A
authors.lastname: Louvet
authors.forename: Sébastien
authors.initials: S
authors.lastname: Dharancy
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Trinchet
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.forename: Philippe
authors.initials: P
authors.lastname: Mathurin
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality*; D018450:Disease Progression; D055088:Early Detection of Cancer / Q000379:methods*; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality / Q000821:virology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality*; D008390:Markov Chains; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000998:Antiviral Agents