Abstract
Introduction: Surveillance for hepatocellular carcinoma (HCC) is recommended by national and international guidelines. However, there are no trial data on whether surveillance improves clinical outcomes in a UK cirrhosis population of mixed aetiology. Our aim was to determine the impact of, and adherence to, surveillance on overall survival. Methods: We prospectively collected data on consecutive patients diagnosed with HCC between January 2009 and December 2015 at two large UK centres. We assessed outcomes depending on whether they had been entered into an HCC surveillance programme, and if they had adhered to that. Results: Out of 985 patients diagnosed with HCC in this study, 40.0% had been enrolled in a surveillance programme. Of these, 76.6% were adherent with surveillance and 24.4% were not. Adherence to surveillance was significantly associated with improved overall survival, even when accounting for lead-time bias using different approaches (HR for 270 days lead-time adjustment 0.64, 0.53 to 0.76, p < 0.001). Conclusions: When adjusted for lead-time bias, HCC surveillance is associated with improved overall survival; however, the beneficial effect of surveillance on survival was lower than reported in studies that did not account fully for lead-time bias.
Highlights
Surveillance for hepatocellular carcinoma (HCC) is recommended by national and international guidelines
When we described lead-time as a variable in our model based on tumour size at presentation in the Edinburgh cohort, we found the beneficial effect of surveillance adherence on overall survival persisted independent of lead-time (Figure 2D)
Surveillance was associated with earlier disease lance in the two largest Scottish regions, HCC surveillance was associated with earlier stage at presentation, increased use of therapy with curative intent, and improved overall disease stage at presentation, increased use of therapy with curative intent, and improved survival from diagnosis
Summary
Surveillance for hepatocellular carcinoma (HCC) is recommended by national and international guidelines. Results: Out of 985 patients diagnosed with HCC in this study, 40.0% had been enrolled in a surveillance programme. Major increases have been reported in HCC incidence in the last 25 years, in Europe and North America [3]. Cirrhosis is the main risk factor for HCC, with up to a third of patients developing. Patients with cirrhosis have a 1 to 5.8% risk per year of developing HCC [7], but regular surveillance may allow early detection and increase access to potentially curative therapies. Five-year survival rates for early stage HCC is more than 70%, compared with less than 5% when diagnosed at an advanced stage [8,9,10]. Most guidelines recommend surveillance is undertaken by 6-monthly ultrasound (US) scan, which has a sensitivity of 58–
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