Background: An enhanced surveillance schedule has been proposed for cirrhotics with viral etiology, who are considered at extremely high-risk of hepatocellular carcinoma (HCC). Aims: We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival. Methods: Data of 777 HBV and HCV cirrhotic patients with HCC diagnosed under a 3-months (n = 109, 3MS group) or a 6-months (n = 668, 6MS group) surveillance were retrieved from the Italian Liver Cancer database. Survival in the 3MS group was considered as observed and adjusted for lead-time bias, and survival analysis was repeated after a propensity score matching. Results: The 3-months surveillance interval neither reduced the share of patients diagnosed outside the Milano criteria, nor increased their probability to receive curative treatments. The median survival of 6MS patients (55.0 months [45.9–64.0]) was not significantly different from the observed (47.0 months [35.0–58.9]; p = 0.43) and adjusted (44.9 months [33.4–56.4]; p = 0.30) survival of 3MS patients. A propensity score analysis confirmed the absence of a survival advantage for 3MS patients. Conclusions: A tightening of surveillance schedule does not increase the diagnosis of early-stage tumors, the feasibility of curative treatments and the survival. Therefore, we should maintain the 6-months interval in the surveillance of viral cirrhotics.
Surveillance for hepatocellular carcinoma with a 3-months interval in “extremely high-risk” patients does not further improve survival / Pelizzaro F.; Peserico G.; D'Elia M.; Cazzagon N.; Russo F.P.; Vitale A.; Giannini E.G.; Piccinnu M.; Rapaccini G.L.; Di Marco M.; Caturelli E.; Zoli M.; Sacco R.; Cabibbo G.; Marra F.; Mega A.; Morisco F.; Gasbarrini A.; Svegliati-Baroni G.; Foschi F.G.; Olivani A.; Masotto A.; Nardone G.; Raimondo G.; Azzaroli F.; Vidili G.; Oliveri F.; Trevisani F.; Farinati F.. - In: DIGESTIVE AND LIVER DISEASE. - ISSN 1590-8658. - STAMPA. - 54:(2022), pp. 927-936. [10.1016/j.dld.2021.08.025]
Surveillance for hepatocellular carcinoma with a 3-months interval in “extremely high-risk” patients does not further improve survival
Marra F.;
2022
Abstract
Background: An enhanced surveillance schedule has been proposed for cirrhotics with viral etiology, who are considered at extremely high-risk of hepatocellular carcinoma (HCC). Aims: We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival. Methods: Data of 777 HBV and HCV cirrhotic patients with HCC diagnosed under a 3-months (n = 109, 3MS group) or a 6-months (n = 668, 6MS group) surveillance were retrieved from the Italian Liver Cancer database. Survival in the 3MS group was considered as observed and adjusted for lead-time bias, and survival analysis was repeated after a propensity score matching. Results: The 3-months surveillance interval neither reduced the share of patients diagnosed outside the Milano criteria, nor increased their probability to receive curative treatments. The median survival of 6MS patients (55.0 months [45.9–64.0]) was not significantly different from the observed (47.0 months [35.0–58.9]; p = 0.43) and adjusted (44.9 months [33.4–56.4]; p = 0.30) survival of 3MS patients. A propensity score analysis confirmed the absence of a survival advantage for 3MS patients. Conclusions: A tightening of surveillance schedule does not increase the diagnosis of early-stage tumors, the feasibility of curative treatments and the survival. Therefore, we should maintain the 6-months interval in the surveillance of viral cirrhotics.
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