title: Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival Among Patients with Cirrhosis in the US.
abstract: Professional societies recommend hepatocellular carcinoma screening in patients with cirrhosis, but high-quality data evaluating its effectiveness to improve early tumor detection and survival in "real world" clinical practice are needed. We aim to characterize the association between hepatocellular carcinoma screening and early tumor detection, curative treatment, and overall survival among patients with cirrhosis.
  
  
  
  We performed a retrospective cohort study of patients diagnosed with hepatocellular carcinoma between June 2012 and May 2013 at 4 health systems in the US. Patients were categorized in the screening group if hepatocellular carcinoma was detected by imaging performed for screening purposes. Generalized linear models and multivariate Cox regression with frailty adjustment were used to compare early detection, curative treatment, and survival between screen-detected and non-screen-detected patients.
  
  
  
  Among 374 hepatocellular carcinoma patients, 42% (n = 157) were detected by screening. Screen-detected patients had a significantly higher proportion of early tumors (Barcelona Clinic Liver Cancer stage A 63.1% vs 36.4%, P <.001) and were more likely to undergo curative treatment (31% vs 13%, P = .02). Hepatocellular carcinoma screening was significantly associated with improved survival in multivariate analysis (hazards ratio 0.41; 95% confidence interval, 0.26-0.65) after adjusting for patient demographics, Child-Pugh class, and performance status. Median survival of screen-detected patients was 14.6 months, compared with 6.0 months for non-screen-detected patients, with the difference remaining significant after adjusting for lead-time bias (hazards ratio 0.59, 95% confidence interval, 0.37-0.93).
  
  
  
  Hepatocellular carcinoma screening is associated with increased early tumor detection and improved survival; however, a minority of hepatocellular carcinoma patients are detected by screening. Interventions to increase screening use in patients with cirrhosis may help curb hepatocellular carcinoma mortality rates.
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, Tex; Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Tex; Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Tex. Electronic address: amit.singal@utsouthwestern.edu.
authors.forename: Amit G
authors.initials: AG
authors.lastname: Singal
authors.affiliation: Department of Internal Medicine, Baylor College of Medicine, Houston, Tex.
authors.forename: Sahil
authors.initials: S
authors.lastname: Mittal
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, Tex.
authors.forename: Olutola A
authors.initials: OA
authors.lastname: Yerokun
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Tex.
authors.forename: Chul
authors.initials: C
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center and Parkland Health and Hospital System, Dallas, Tex.
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Marrero
authors.affiliation: Department of Surgery, UT Southwestern Medical Center, Dallas, Tex.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Yopp
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor.
authors.forename: Neehar D
authors.initials: ND
authors.lastname: Parikh
authors.affiliation: Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill.
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Scaglione
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology; D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology
keywords: Cirrhosis; Liver cancer; Screening