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Liver cancer screening did not reduce mortality in cirrhosis cases

Screening patients with cirrhosis for hepatocellular carcinoma using either or both abdominal ultrasonography and serum alpha fetoprotein did not correlate with decreased HCC-related mortality, according to a study recently published in Gastroenterology.

Andrew M. Moon , MD, from the University of North Carolina School of Medicine, and colleagues performed a matched case-control study to evaluate the outcomes of HCC screening using abdominal ultrasonography (USS) and serum alpha fetoprotein (AFP). The study comprised 238 pairs of cases and matched controls.

The researchers selected patients from the Veterans Affairs health care system. Patients received their HCC diagnosis via multiphasic computed tomography or magnetic resonance imaging (85.6%) or through histological diagnosis (28.8%).

The researchers observed no difference between cases and controls in the proportion of USS screenings (52.9% vs. 54.2%), AFP screenings (74.8% vs. 73.5%), or either screening technique (81.1% vs. 79.4%) within 4 years prior to index date.

No combination of screenings with USS and AFP correlated with HCC-related mortality at the 1-year, 2-year, 3-year or 4-year analysis intervals.

According to Moon and colleagues, multiple studies have suggested that HCC detected by USS or AFP screening tends to be at an earlier stage at diagnosis than HCC detected by symptoms, signs or incidental imaging.

“Screening is more likely to identify the slow-growing tumors, which have lower stage, and more likely to miss the fast-growing tumors, which are then identified at a higher stage by symptoms,” the researchers wrote. “It is possible that the HCCs most likely to lead to death are HCCs least likely to be identified by current screening modalities at an early stage. Whether early treatment for HCC in patients with cirrhosis leads to a reduction in case-fatality is questionable.”

Moon and colleagues recommend additional case-control studies to evaluate the efficacy of screening for HCC in other health care systems. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.