The Effect of Hepatocellular Carcinoma Surveillance in an Urban Population With Liver Cirrhosis.
BACKGROUND
Hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis is aimed at early detection so that effective therapeutic options may be offered. We undertook this study to assess the patterns of surveillance that had been offered to HCC patients evaluated at our center, and the effect of these strategies on outcome.


METHODS
Consecutive patients, age 18 years and older, diagnosed with HCC between December 2007 and December 2012 were identified. Surveillance was defined as α-fetoprotein measurement and/or imaging examination in the 12 months before HCC diagnosis. Logistic regression and survival analysis models were utilized to investigate the association of surveillance with patient characteristics and survival.


RESULTS
A total of 305 patients with HCC and a background of cirrhosis were analyzed. HCC was detected by surveillance in 131 patients (43%). Of those who underwent surveillance, 92% were diagnosed with early-stage cancer (stages I and II) compared with 62% of those who did not undergo surveillance (P<0.001). The rate of surgical therapy (hepatic resection and liver transplantation) was almost doubled in the surveillance group (61% vs. 33%, P<0.05). At median follow-up of 27.3 months, overall survival was high at 55% and surveillance was significantly associated with longer survival (P=0.006).


CONCLUSIONS
At our center, surveillance efficacy for HCC detection was notably higher than earlier reported.


CONCLUSIONS
Patients who underwent surveillance were more likely to have their tumors detected at an early stage, to qualify for surgical therapy, and to have improved survival.
*Transplant Institute, Georgetown University Hospital †Lombardi Comprehensive Cancer Center, Georgetown University Medical Center ‡Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Washington, DC.
Jeffrey D
JD
Nusbaum
John
J
Smirniotopoulos
Henry C
HC
Wright
Chiranjeev
C
Dash
Tarina
T
Parpia
Joanna
J
Shechtel
Yaojen
Y
Chang
Christopher
C
Loffredo
Kirti
K
Shetty
D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D004219:District of Columbia; D055088:Early Detection of Cancer / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012720:Severity of Illness Index; D016019:Survival Analysis; D014505:Urban Population / Q000706:statistics & numerical data*; D000509:alpha-Fetoproteins / Q000032:analysis
C097353:AFP protein, human; D000509:alpha-Fetoproteins