Abstract
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Highlights
Why did so few of the patients with hepatocellular carcinoma (HCC) receive curative treatments? Does this suggest that screening benefit was not observed because curative treatments were not readily available in the Veteran’s Affairs (VA) Healthcare System? It is important to recognize that the cases of HCC included in the study were, by definition, all fatal cases in whom the HCC was judged to have caused death
The reason that many patients with early stage HCC do not receive potentially curative treatments is the stringent eligibility criteria for liver transplantation and many contraindications to surgical resection or even ablation, even among patients judged by the Milan criteria to have early-stage disease
We conducted additional analyses in which we considered screening tests performed within 1, 2, or 3 years from the index date. This was to account for the observation that, when different time periods yield different odds ratios, the lowest odds ratio is likely to be the least biased.[2]
Summary
Does this suggest that screening benefit was not observed because curative treatments were not readily available in the Veteran’s Affairs (VA) Healthcare System? The reason that many patients with early stage HCC do not receive potentially curative treatments is the stringent eligibility criteria for liver transplantation and many contraindications to surgical resection or even ablation, even among patients judged by the Milan criteria to have early-stage disease.
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