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Surveillance prior to HCC diagnosis increases survival

Researchers in The Netherlands found that surveillance before hepatocellular carcinoma diagnosis improved overall survival in real-life practice, as well as decreased tumor size and increased surgical therapy time, according to study data published in the Journal of Hepatology. 

“Currently, several international guidelines advise regular surveillance of patients at increased HCC risk,” the researchers wrote. “The goal is to detect HCC at earlier stages, enabling curative therapies with a better outcome and decreased mortality. Nonetheless, surveillance is controversial. … We investigate the contribution of surveillance in a large group of HCC patients in ‘real life’ clinical practice in the Netherlands.”

The researchers evaluated data of 1,074 patients diagnosed with HCC between January 2005 and December 2012 from five Dutch academic centers. Of these patients, 27% underwent surveillance for HCC (n = 295). Surveillance via ultrasound, CT or MRI was performed in 17% of patients and in combination with alpha-fetoprotein (AFP) in 83%. The median time interval between last negative radiologic imaging and diagnosis of HCC was 7.5 months, of which 60% of patients had less than 9 months and 40% had greater than 9 months interval.

Viral hepatitis was more common among patients in the surveillance group as the underlying cause of liver disease (61%) compared with the nonsurveillance group (27%), whereas NAFLD (20% vs. 7%) and absence of cause of liver disease (18% vs. 3%) were more common among the nonsurveillance group compared with the surveillance group. Cirrhosis was found in 97% of patients in the surveillance group and in 60% of the nonsurveillance group (P < .001).

In the surveillance group, 56% had a single tumor compared with 50% in the nonsurveillance group. Also among the surveillance group, tumor size was smaller (2.7 cm) compared with the nonsurveillance group (6 cm), AFP levels were lower (16 vs. 44 μg/L), HCC was found at an earlier tumor stage (61% vs. 21%) and resection/transplantation (34% vs. 25%) or radiofrequency ablation (23% vs. 7%) were used more often.

The surveillance group had a 68% survival rate at 1 year, 47% survival rate at 3 years and 39% survival rate at 5 years compared with the nonsurveillance group (55%, 29% and 22%).

“Survival benefit by surveillance remained significant after adjustment for lead-time bias based on assumed tumor doubling time of 90 days, but not with doubling time of [more than] 120 days,” the researchers wrote.

Multivariate analysis showed surveillance to be an independent predictor for mortality both less than 9 months (adjusted HR = 0.51; 95% CI, 0.39-0.67) and greater than 9 months (adjusted HR = 0.5; 95% CI, 0.37-0.69).

The researchers concluded: “In this real life study, HCC surveillance was associated with a smaller tumor size, earlier [Barcelona Clinic Liver Cancer tumor stage classification], with impact on therapeutic strategy, and was an independent predictor of increased survival.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.