Hepatocellular carcinoma (HCC) is the main cause of mortality in patients with chronic viral hepatitis (CVH). We determined the impact of surveillance and treatments on long‐term outcomes in patients with CVH who developed HCC. Between 1984 and 2014, 333 patients with HCC and with hepatitis B or hepatitis C virus infection were evaluated. An adjusted lead time bias interval was added to patients with HCC who presented with HCC (no surveillance), and their survival was compared to patients whose HCC was detected by surveillance. After HCC treatments, survival rates within and beyond 3 years of follow‐up were compared. In 175 (53%) patients, HCC was detected through surveillance using alpha‐fetoprotein and abdominal ultrasound examinations. Compared to 158 (47%) patients with HCC who had no surveillance, more patients with HCC detected by surveillance received surgical and locoregional treatments (P <  0.0001 to P <  0.001), and their 1‐, 3‐, and 5‐year overall and disease‐free survival rates were significantly higher (P <  0.001 for both). During the first 3 years of follow‐up, patients with HCC receiving liver transplantation had similar survival rates as those with liver resection or radiofrequency ablation (RFA); however, due to HCC recurrence, survival in resection and RFA patients became significantly less when followed beyond 3 years (P =  0.001 to P =  0.04). Factors associated with mortality included tumors beyond University of California at San Francisco criteria (hazard ratio [HR] 2.02; P <  0.0001), Child‐Pugh class B and C (HR, 1.58‐2.26; P =  0.043 to P =  0.015, respectively), alpha‐fetoprotein per log ng/mL increase (HR, 1.30; P <  0.0001), previous antiviral therapy in hepatitis B virus patients (HR, 0.62; P =  0.032), and treatments other than liver transplantation (HR, 2.38‐6.45; P <  0.0001 to P < 0.003). Conclusion. Patients with HCC detected by surveillance had prolonged survival. Due to HCC recurrence, survival rates after liver resection and RFA were lower when followed beyond 3 years after treatments. (Hepatology Communications 2017;1:595–608)

Aim: Survival in patients with hepatocellular carcinoma (HCC) is impacted by stage of liver disease, tumor characteristics, and HCC surveillance in high-risk individuals. Factors associated with HCC tumor growth rate (TGR) and its influence on recurrence-free survival after treatment was investigated. Methods: TGR was calculated in 164 HCC patients with chronic viral hepatitis who had two consecutive magnetic resonance imaging or computed tomography scans ≥ 30 days apart prior to treatment and who were followed prospectively to determine the rates of recurrence-free survival. Results: The median TGR in 164 patients was 17.8% per month (mean 33.3% per month). Regression tree analysis indicated that the top three predictors of TGR were alpha-fetoprotein (AFP) levels (≥ 16.7 ng/mL), platelet counts (≥ 140,000 mm 3), and serum albumin level (< 3.55 g/dL). The regression tree identified patient groups with TGRs ranging from 0.65% to 39.4% per month. At a median follow-up of 22 months, the overall recurrence-free survival was 53.8%.