Liver and Bile

J Hepatol. 2022;77(1):128–39

Singal AG, Zhang E, Narasimman M, Rich NE, Waljee AK, Hoshida Y, Yang JD, Reig M, Cabibbo G, Nahon P, Parikh ND, Marrero JA

HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: A meta-analysis

Background and aims: There is controversy regarding the overall value of hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis given the lack of data from randomized-controlled trials. To address this issue, the authors conducted a systematic review and meta-analysis of cohort studies evaluating the benefits and harms of HCC surveillance in patients with cirrhosis.
Methods: They performed a search of the Medline and Embase databases and national meeting abstracts from January 2014 through July 2020 for studies reporting early-stage HCC detection, curative treatment receipt, or overall survival, stratified by HCC surveillance status, among patients with cirrhosis. Pooled risk ratios (RRs) and hazard ratios (HRs), according to HCC surveillance status, were calculated for each outcome using the DerSimonian and Laird method for random-effects models.
Results: 59 studies including 145,396 patients with HCC, which was detected by surveillance in 41,052 cases (28.2%), were identified. HCC surveillance was associated with improved early-stage detection (RR = 1.86, 95% confidence interval [CI]: 1.73–1.98; I2 = 82%), curative treatment receipt (RR = 1.83, 95% CI: 1.69–1.97; I2 = 75%), and overall survival (HR = 0.67, 95% CI: 0.61–0.72; I2 = 78%) after adjusting for lead-time bias; however, there was notable heterogeneity in all pooled estimates. Four studies examined surveillance-related physical harms due to false-positive or indeterminate surveillance results, but no studies examined potential financial or psychological harms. The proportion of patients experiencing surveillance-related physical harms ranged from 8.8% to 27.5% across studies, although most harms were mild in severity.

Conclusion: Hepatocellular carcinoma (HCC) surveillance is associated with improved early detection, curative treatment receipt, and survival in patients with cirrhosis, although there was heterogeneity in pooled estimates. Available data suggest HCC surveillance is of high value in patients with cirrhosis, although continued rigorous studies evaluating benefits and harms are still needed.

A.G. Singal, M.D., Professor of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX, USA,

DOI: 10.1016/j.jhep.2022.01.023

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