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J Gastrointest Surg. 2013 Oct;17(10):1774-83. doi: 10.1007/s11605-013-2302-6. Epub 2013 Aug 14.

Trends and patterns of utilization in post-treatment surveillance imaging among patients treated for hepatocellular carcinoma.

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1
Department of Surgery, Johns Hopkins University School of Medicine, Blalock 688 600N. Wolfe Street, Baltimore, MD, 21287, USA.

Abstract

BACKGROUND:

Little is known about the patterns of utilization of surveillance imaging after treatment of hepatocellular carcinoma (HCC). We sought to define population-based patterns of surveillance and investigate if intensity of surveillance impacted outcome following HCC treatment.

METHODS:

The Surveillance, Epidemiology, and End Results-Medicare database was used to identify patients with HCC diagnosed between 1998 and 2007 who underwent resection, ablation, or intra-arterial therapy (IAT). The association between imaging frequency and long-term survival was analyzed.

RESULTS:

Of the 1,467 patients, most underwent ablation only (41.5%), while fewer underwent liver resection only (29.6 %) or IAT only (18.3%). Most patients had at least one CT scan (92.7%) during follow-up, while fewer had an MRI (34.1%). A temporal trend was noted with more frequent surveillance imaging obtained in post-treatment year 1 (2.5 scans/year) vs. year 5 (0.9 scans/year; P = 0.01); 34.5% of alive patients had no imaging after 2 years. Frequency of surveillance imaging correlated with procedure type (total number of scans/5 years, resection, 4.7; ablation, 4.9; IAT, 3.7; P < 0.001). Frequency of surveillance imaging was not associated with a survival benefit (three to four scans/year, 49.5 months vs. two scans/year, 71.7 months vs. one scan/year, 67.6 months; P = 0.01) CONCLUSION: Marked heterogeneity exists in how often surveillance imaging is obtained following treatment of HCC. Higher intensity imaging does not confer a survival benefit.

PMID:
23943387
PMCID:
PMC3979288
DOI:
10.1007/s11605-013-2302-6
[Indexed for MEDLINE]
Free PMC Article
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