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Hepatocellular Carcinoma Screening Is Associated With Increased Survival of Patients With Cirrhosis
| Content Provider | Scilit |
|---|---|
| Author | Choi, Debra T. Kum, Hye-Chung Park, Sulki Ohsfeldt, Robert L. Shen, Yu Parikh, Neehar D. Singal, Amit G. |
| Copyright Year | 2018 |
| Description | Journal: Clinical Gastroenterology and Hepatology |
| Abstract | Hepatocellular carcinoma (HCC) screening of patients with cirrhosis is recommended by professional societies to increase detection of early-stage tumors and survival but is underused in clinical practice. We conducted a retrospective cohort study of 13,714 patients diagnosed with HCC from 2003 through 2013 included in the Surveillance, Epidemiology, and End Results Program-Medicare database. We characterized receipt of HCC screening in the 3 years before HCC diagnosis using mutually exclusive categories (consistent vs inconsistent vs no screening) and proportion of time covered with screening. Correlates for screening receipt were assessed using a multivariable 2-part regression model. We examined the association between screening receipt and early detection of tumors using multivariable logistic regression. We evaluated associations between screening receipt and overall survival using a Cox proportional hazards model, after adjustments for effects of lead-time bias and length-time bias on survival rate estimators. Most patients with cirrhosis (51.1%) did not receive any screening in the 3 years before a diagnosis of HCC, and only 6.8% of patients underwent consistent annual screening. The proportion with consistent screening increased from 5.4% in 2003–2006 to 8.8% in 2011–2013 (P<.001). The mean proportion of time covered was 13.4% overall, which increased from 11.7% in 2003–2006 to 15.2% in 2011–2013. Receipt of consistent screening was associated with detection of early-stage tumors (odds ratio, 1.98; 95% CI, 1.68–2.33) and reduced risk of death after correction for lead time bias (hazard ratio, 0.76; 95% CI, 0.70–0.83). Inconsistent screening was associated with a slightly smaller increase in early detection of HCC (odds ratio, 1.31; 95% CI, 1.20–1.43) and reduced risk of death (hazard ratio, 0.86; 95% CI, 0.83–0.90). After correction for lead- and length-time biases, higher proportions of patients with consistent (23%; 95% CI, 21%–25%) and inconsistent screening (19%; 95% CI, 19%–20%) survived for 3 years compared to patients without screening (13%; 95% CI, 12%–14%). In an analysis of the Surveillance, Epidemiology, and End Results Program-Medicare database, we found HCC screening to be underused for patients with cirrhosis. This contributes to detection of liver tumors at later stages and shorter times of survival. However, the proportion of patients screened for HCC has increased over time. |
| Related Links | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431264/pdf http://www.cghjournal.org/article/S1542356518311546/pdf |
| ISSN | 15423565 |
| e-ISSN | 15427714 |
| DOI | 10.1016/j.cgh.2018.10.031 |
| Journal | Clinical Gastroenterology and Hepatology |
| Issue Number | 5 |
| Volume Number | 17 |
| Language | English |
| Publisher | Elsevier BV |
| Publisher Date | 2018-10-25 |
| Access Restriction | Open |
| Subject Keyword | Journal: Clinical Gastroenterology and Hepatology Gastroenterology and Hepatology Seer Database Analysis Liver Cancer |
| Content Type | Text |
| Resource Type | Article |
| Subject | Hepatology Gastroenterology |
