Screening for Hepatocellular Carcinoma: Are We Following Guidelines?

Abstract

Purpose: The incidence of hepatocellular carcinoma (HCC) in cirrhotic patients is increasing worldwide. Cirrhotic patients should receive HCC screening and surveillance according to the American Association for the Study of Liver Disease (AASLD) guidelines. The purpose of this study was to identify the current screening and surveillance patterns for cirrhotic patients with HCC in clinical practice. Methods: A retrospective, descriptive, cross-sectional design was used for this study. Data were collected from subjects who were referred to a specialty hepatology division for treatment. Cirrhotic patients diagnosed with HCC and meeting the inclusion and exclusion criteria were used in this study. The aim of the study was to identify the clinical patterns of practitioners screening for HCC in cirrhotic patients. Validity and reliability for the data collection tool was not established. Variables that were studied included demographic data, etiology of cirrhosis, type of HCC screening, time increments of screening, and size of tumor at the time of diagnosis. The data were analyzed with the use of crosstabs, frequency, and correlation statistics. Results: Despite the recommended HCC screening and surveillance guidelines, analysis of 37 patients indicated that cirrhotic patients are not screened as recommended. Cirrhosis is diagnosed late in the disease process, although many of the patients are followed by a specialist. Hepatitis C was the primary cause of cirrhosis in over 55% of the patients. The different screening patterns that were identified were none, sporadic, and annual (every 6 months to 1 year). The patterns differed by the practitioner managing the patient. Although over 50% of the patients in this study did not receive optimal HCC screening, over 50% of them did receive optimal treatment for their HCC. A few of the patients were receiving palliative treatment. In 2013, this research was repeated, analyzing 109 patients and using the same criteria and center as the preliminary study. The findings were similar. Over 55% of the patients were diagnosed with HCV. Also, 50% were diagnosed with HCC within 5 years of the HCV diagnosis. The HCC screening and surveillance was also sporadic, and had a mean of one-time screen with either US, AFP, CT, or MRI during the follow-up. Conclusion: The findings of both descriptive research analyses indicates that cirrhosis is diagnosed late, and patients are not screened as recommended for HCC. These research findings are important in clinical practice because patients rely on practitioners to follow evidence-based practice. Early HCC detection and referrals can be lifesaving, and can change treatment options. Late HCC diagnosis limits treatment options in relation to TACE and OLT, and can be detrimental.