HCC surveillance results in earlier HCC detection: results from an Indian cohort.
Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death worldwide, with an increased incidence in South Asia. In order to describe the effect of surveillance for HCC with biannual ultrasound and alpha-fetoprotein (AFP) on diagnosis and survival in an Indian population a retrospective cohort-control study was performed at two liver clinics in India. The medical records of 3,258 patients with cirrhosis who received surveillance for HCC were reviewed, and 100 patients who developed HCC identified. Sixty-four cirrhotic patients diagnosed with HCC during the same time period without a history of surveillance were included and survival, BCLC stage at diagnosis, and treatment were compared. Patients who underwent surveillance were more likely to be diagnosed with potentially curable or treatable BCLC Stage 0/A disease and Stage B/C disease respectively, than late Stage D disease (χ2 = 0.0007). Patients diagnosed at an earlier stage of HCC lived significantly longer after diagnosis than patients diagnosed at a later stage (Stage 0/A: 15.6 ± 14.2 months vs. Stage B/C: 9.43 ± 19.7 months vs. Stage D: 5.59 ± 11.9 months; p = 0.0006). While treatment for HCC improved overall survival, only 28% of eligible patients received treatment, explaining the lack of survival benefit noted in the surveillance group. Surveillance for HCC led to detection of HCC at earlier stages. The impact of surveillance on improved mortality could not be evaluated given the limited number of patients who received treatment. HCC surveillance has the potential to improve survival in South Asian patients with cirrhosis only if improvements in access to appropriate treatment are made.
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA ; Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc. (formerly SAIC-Frederick, Inc.), Frederick National Laboratory for Cancer Research, Frederick, MD 21702 USA.
Anita
A
Kohli
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA.
Allison A
AA
Murphy
Department of Gastroenterology, Jaslok Hospital, Mumbai, India.
Chirdeep
C
Agarwal
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA.
Bhavana
B
Shivakumar
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA.
Shyam
S
Kottilil
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA.
Michael A
MA
Polis
Gilead Sciences, Foster City, CA USA.
G Mani
GM
Subramanian
Dayanand Medical College & Hospital, Ludhiana, India.
Vandana
V
Midha
Dayanand Medical College & Hospital, Ludhiana, India.
Omesh
O
Goyal
Department of Radiology, Jaslok Hospital, Mumbai, India.
Srinivas
S
Desai
Dayanand Medical College & Hospital, Ludhiana, India.
Ajit
A
Sood
Department of Gastroenterology, Jaslok Hospital, Mumbai, India.
Samir
S
Shah
Hepatocellular carcinoma; India; Surveillance; Survival; Treatment; Ultrasounds