Surveillance for hepatocellular carcinoma is associated with increased survival: Results from a large cohort in the Netherlands
SourceJournal of Hepatology, 63, 5, (2015), pp. 1156-1163
Article / Letter to editor
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Journal of Hepatology
SubjectRadboudumc 0: Other Research RIMLS: Radboud Institute for Molecular Life Sciences
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 18months before diagnosis. RESULTS: 295 (27%) of 1074 cases underwent surveillance. Median time interval between last negative radiologic imaging and hepatocellular carcinoma diagnosis was 7.5months. 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. 6.0cm), with lower alpha-fetoprotein levels (16 vs. 44mug/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 90days, but not with doubling time of 120days. In multivariate analysis, surveillance was an independent predictor for mortality (for interval 9 respectively >9months: 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.
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