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J Hepatol. 2015 Nov;63(5):1156-63. doi: 10.1016/j.jhep.2015.06.012. Epub 2015 Jun 20.

Surveillance for hepatocellular carcinoma is associated with increased survival: Results from a large cohort in the Netherlands.

Author information

1
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
2
Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands.
3
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
4
Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands.
5
Department of Medical Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
6
Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
7
Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
8
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: k.j.vanerpecum@umcutrecht.nl.

Abstract

BACKGROUND & AIMS:

Effectiveness of surveillance for hepatocellular carcinoma is controversial. We here explore its effects in "real life" clinical practice.

METHODS:

Patients with hepatocellular carcinoma diagnosed in the period 2005-2012 in five Dutch academic centers were evaluated. Surveillance was defined as ⩾2 screening tests during three preceding years and at least one radiologic imaging test within 18 months before diagnosis.

RESULTS:

295 (27%) of 1074 cases underwent surveillance. Median time interval between last negative radiologic imaging and hepatocellular carcinoma diagnosis was 7.5 months. In the surveillance group, cirrhosis (97% vs. 60%, p<0.001) and viral hepatitis were more frequent, and non-alcoholic fatty liver disease or absence of risk factors less frequent. In case of surveillance, tumor size was significantly smaller (2.7 vs. 6.0 cm), with lower alpha-fetoprotein levels (16 vs. 44 μg/L), earlier tumor stage (BCLC 0 and A combined: 61% vs. 21%) and resection/transplantation (34% vs. 25%) or radiofrequency ablation (23% vs. 7%) more often applied, with significantly higher 1-, 3-, and 5-year survival rates. 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 ⩾120 days. In multivariate analysis, surveillance was an independent predictor for mortality (for interval ⩽9 respectively >9 months: adjusted HRs 0.51 and 0.50, 95% confidence intervals: 0.39-0.67 and 0.37-0.69).

CONCLUSIONS:

Surveillance for hepatocellular carcinoma was associated with smaller tumor size, earlier tumor stage, with an impact on therapeutic strategy and was an independent predictor of survival.

KEYWORDS:

Hepatocellular carcinoma; Surveillance; Survival

PMID:
26100498
DOI:
10.1016/j.jhep.2015.06.012
[Indexed for MEDLINE]

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