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Improved Survival of Hepatocellular Carcinoma Patients Diagnosed with a Dedicated Screening Programme—a Propensity Score Adjusted Analysis

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Abstract

Aim

To assess the overall survival (OS) in those with hepatocellular carcinoma (HCC) diagnosed within a programmatic, centrally co-ordinated, regional screening programme.

Methods

A retrospective cohort analysis of consecutive HCC patients diagnosed between 2004 and 2013. Patients were followed up till death or end of study period (30 April 2015). A dedicated screening programme was commenced in 2009 to screen high-risk patients for HCC. Primary objective is to compare the OS between HCC patients diagnosed within the screening group versus those diagnosed outside this group. Other objectives were to compare tumour stage at diagnosis and the proportion having curative treatments in the two groups. Propensity score adjustments were performed to assess the survival benefit.

Results

HCC was diagnosed in 130 subjects during the study period (82.3% males, median [IQR] age 62 [± 19] years and median [IQR] follow-up of 11.3 (± 23.5) months). Ninety-six patients (73.8%) died during the follow-up, and the median (95%CI) OS was 15.7 (9.7–21.8) months. HCC diagnosed within the screening programme had a better OS compared to those diagnosed outside this programme (26.8 vs 11.5 months, p = 0.01). Further, those diagnosed within the programme had an earlier stage HCC ([58.3% vs 23.6%], Ӽ2 = 11.3, p = 0.001), and a significant proportion were treated with curative intent ([62.5% vs 31.1%], Ӽ2 = 8.3, p = 0.004). Propensity score adjustment showed a 58% reduction in mortality for HCC diagnosed within the screening programme (HR [95%CI] 0.42 [0.20–0.89], p = 0.02).

Conclusion

A programmatic, regional HCC screening programme improved the OS and detected tumours at an earlier stage enabling more patients to have curative therapies.

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References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69–90.

    Article  Google Scholar 

  2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.

    Article  Google Scholar 

  3. Clark HP, et al. Staging and current treatment of hepatocellular carcinoma. Radiographics. 2005;25(Suppl 1):S3–23.

    Article  Google Scholar 

  4. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020–2.

    Article  Google Scholar 

  5. Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67(1):358–80.

    Article  Google Scholar 

  6. European Association for the Study of the Liver. Electronic address, e.e.e. and L. European Association for the Study of the, EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182–236.

    Article  Google Scholar 

  7. Omata M, Cheng AL, Kokudo N, Kudo M, Lee JM, Jia J, et al. Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma: a 2017 update. Hepatol Int. 2017;11(4):317–70.

    Article  Google Scholar 

  8. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol. 2004;130(7):417–22.

    Article  Google Scholar 

  9. Poustchi H, Farrell GC, Strasser SI, Lee AU, McCaughan GW, George J. Feasibility of conducting a randomized control trial for liver cancer screening: is a randomized controlled trial for liver cancer screening feasible or still needed? Hepatology. 2011;54(6):1998–2004.

    Article  Google Scholar 

  10. Kennedy NA, Rodgers A, Altus R, McCormick R, Wundke R, Wigg AJ. Optimisation of hepatocellular carcinoma surveillance in patients with viral hepatitis: a quality improvement study. Intern Med J. 2013;43(7):772–7.

    Article  CAS  Google Scholar 

  11. Davila JA, Morgan RO, Richardson PA, du XL, McGlynn KA, el-Serag HB. Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States. Hepatology. 2010;52(1):132–41.

    Article  Google Scholar 

  12. Noda I, Kitamoto M, Nakahara H, Hayashi R, Okimoto T, Monzen Y, et al. Regular surveillance by imaging for early detection and better prognosis of hepatocellular carcinoma in patients infected with hepatitis C virus. J Gastroenterol. 2010;45(1):105–12.

    Article  Google Scholar 

  13. Mittal S, Kanwal F, Ying J, Chung R, Sada YH, Temple S, et al. Effectiveness of surveillance for hepatocellular carcinoma in clinical practice: a United States cohort. J Hepatol. 2016;65(6):1148–54.

    Article  Google Scholar 

  14. Cucchetti A, Trevisani F, Pecorelli A, Erroi V, Farinati F, Ciccarese F, et al. Estimation of lead-time bias and its impact on the outcome of surveillance for the early diagnosis of hepatocellular carcinoma. J Hepatol. 2014;61(2):333–41.

    Article  Google Scholar 

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Authors and Affiliations

  1. Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Bedford Park, SA, Australia

    Mohamed A. Chinnaratha, Kirsty Campbell, Ryan Mathias, Rosemary J. McCormick & Alan J. Wigg

  2. School of Medicine, Flinders University, Bedford Park, Australia

    Mohamed A. Chinnaratha, Richard J. Woodman & Alan J. Wigg

  3. School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia

    Mohamed A. Chinnaratha

Authors
  1. Mohamed A. Chinnaratha
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  2. Kirsty Campbell
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  3. Ryan Mathias
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  4. Rosemary J. McCormick
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  5. Richard J. Woodman
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  6. Alan J. Wigg
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Corresponding author

Correspondence to Mohamed A. Chinnaratha.

Ethics declarations

The study protocol was approved by the Southern Adelaide Clinical Human Research Ethics Committee (SAC HREC).

Conflict of Interest

The authors declare that they have no conflict of interest.

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Chinnaratha, M.A., Campbell, K., Mathias, R. et al. Improved Survival of Hepatocellular Carcinoma Patients Diagnosed with a Dedicated Screening Programme—a Propensity Score Adjusted Analysis. J Gastrointest Canc 50, 888–893 (2019). https://doi.org/10.1007/s12029-018-0171-7

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  • DOI: https://doi.org/10.1007/s12029-018-0171-7

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