Is hepatocellular carcinoma surveillance in high-risk populations effective?

Abstract

Several professional societies recommend hepatocellular carcinoma (HCC) surveillance in high-risk patients including patients with cirrhosis from any etiology and subsets of noncirrhotic chronic hepatitis B virus infection. The efficacy of HCC surveillance to increase early detection and improve survival has been demonstrated in a large randomized controlled trial among hepatitis B virus patients and several cohort studies among those with cirrhosis. However, the effectiveness on HCC surveillance, when applied in clinical practice, is lower due to low utilization of HCC surveillance among at-risk patients, poorer test performance given operator dependency and differences in patient characteristics, and downstream process failures such as treatment delays. Interventions to increase surveillance utilization and improve surveillance test performance should improve surveillance effectiveness in the future.

Diagnostic Performance of AFP, AFP-L3, or PIVKA-II for Hepatitis C Virus-Associated Hepatocellular Carcinoma: A Multicenter Analysis

“…The five-year overall survival ranges from 50–80% in patients with early-stage disease and less than 10% for patients with late and advanced stages of HCC [ 5 , 6 ]. The benefits of HCC surveillance on survival with detection of HCC at early stages [ 7 , 8 , 9 , 10 , 11 ] have been reported resulting in many guidelines recommending HCC surveillance for at-risk populations, including patients with cirrhosis and/or chronic hepatitis infection [ 6 , 12 , 13 , 14 ].…”

Rational HCC screening approaches for patients with NAFLD

“…Observational studies may also underestimate the efficacy of HCC surveillance because they often lack rigorous implementation and timely diagnosis and treatment of HCC. Some contemporary data suggest HCC surveillance may not be of benefit in patients with cirrhosis, with a nested case-control study from the Veterans Affairs Health System failing to find an association between surveillance receipt and improved survival (11) although the retrospective nationwide practice based observational setting was inevitably associated with delays in diagnosis treatment of HCC that would reduce the effectiveness of HCC surveillance (13). Overall, the available studies provide a moderately strong rationale supporting HCC surveillance as efficacious in patients with chronic HBV or cirrhosis in general but contain little specific information for or against HCC surveillance in NAFLD or NAFLD cirrhosis.…”

“…Several studies demonstrate the cost of screening per quality-adjusted life year (QALY) decreases with increasing HCC risk. Although HCC risk is one of the most important factors in determining cost-effectiveness of HCC surveillance, decision analyses also found surveillance utilization and test performance are important determinants of HCC surveillance effectiveness and ability to afford a survival benefit (11). Cost effectiveness analyses indicate that HCC screening should be considered for patients with Child Pugh A cirrhosis and HCC risk exceeding 1.0%-1.5% per year, with the lower end of the range reported by more recent cost-effectiveness analysis that incorporate contemporary estimates of sensitivity and specificity of screening and the effectiveness of curative treatments.…”

Network profiling of hepatocellular carcinoma targets for evidence based pharmacological approach to improve clinical efficacy

“…Several aetiologies which can lead to chronic liver pathologies also considerably increase the risk of developing HCC 2 . Screening for liver diseases in primary healthcare does not seem to be optimal as incidence of HCC has progressively increased in the last decade 3 . Early detection of HCC is key to disease management as it can be effectively treated by surgical approaches.…”