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    Liver and Bile

    Clin Gastroenterol Hepatol. 2024;22(2):295–304.e2

    Daher D, Seif El Dahan K, Cano A, Gonzales M, Ransom C, Jaurez E, Carranza O, Quirk L, Morgan T, Gopal P, Patel MS, Lieber S, Louissaint J, Cotter TG, VanWagner LB, Yang JD, Parikh ND, Yopp A, Rich NE, Singal AG

    Hepatocellular carcinoma surveillance patterns and outcomes in patients with cirrhosis


    Background and aims: Hepatocellular carcinoma (HCC) surveillance is associated with improved early detection and reduced mortality, although practice patterns and effectiveness vary in clinical practice. The authors aimed to characterize HCC surveillance patterns in a large, diverse cohort of patients with HCC.
    Methods: They conducted a retrospective cohort study of patients diagnosed with HCC between January 2008 and December 2022 at 2 large US health systems. They recorded imaging receipt in the year before HCC diagnosis: ultrasound plus α-fetoprotein (AFP), ultrasound alone, multiphasic contrast-enhanced computed tomography (CT)/magnetic resonance imaging (MRI), and no liver imaging. Multivariable logistic and Cox regression analysis were used to compare early tumor detection, curative treatment receipt, and overall survival between surveillance strategies.
    Results: Among 2028 patients with HCC (46.7% Barcelona Clinic Liver Cancer stage A), 703 (34.7%) had ultrasound plus AFP, 293 (14.5%) had ultrasound alone, 326 (16.1%) had multiphasic CT/MRI, and 706 (34.8%) had no imaging in the year before HCC diagnosis. Over the study period, proportions without imaging were stable, whereas use of CT/MRI increased. Compared with no imaging, CT/MRI and ultrasound plus AFP, but not ultrasound alone, were associated with early-stage HCC detection and curative treatment. Compared with ultrasound alone, CT/MRI and ultrasound plus AFP were associated with increased early-stage detection.

    Conclusions: Hepatocellular carcinoma surveillance patterns vary in clinical practice and are associated with differing clinical outcomes. While awaiting data to determine if computed tomography or magnetic resonance imaging surveillance can be performed in a cost-effective manner in selected patients, α-fetoprotein has a complementary role to ultrasound-based surveillance, supporting its adoption in practice guidelines.

    A.G. Singal, M.D., Professor of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA, E-Mail: amit.singal@utsouthwestern.edu

    DOI: 10.1016/j.cgh.2023.08.003

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