Liver and Bile

Dig Liver Dis. 2022;54(7):927–36

Pelizzaro F, Peserico G, D’Elia M, Cazzagon N, Russo FP, Vitale A, Giannini EG, Piccinnu M, Rapaccini GL, Di Marco M, Caturelli E, Zoli M, Sacco R, Cabibbo G, Marra F, Mega A, Morisco F, Gasbarrini A, Svegliati-Baroni G, Foschi FG, Olivani A, Masotto A, Nardone G, Raimondo G, Azzaroli F, Vidili G, Oliveri F, Trevisani F, Farinati F; Italian Liver Cancer (ITA.LI.CA) Study Group

Surveillance for hepatocellular carcinoma with a 3-months interval in “extremely high-risk” patients does not further improve survival

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: The authors compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival.
Methods: Data of 777 hepatitis B virus and hepatitis C virus 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 [45.9–64.0] months) was not significantly different from the observed (47.0 [35.0–58.9] months; p = 0.43) and adjusted (44.9 [33.4–56.4] months; 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, the 6-months interval in the surveillance of viral cirrhotics should be maintained.

Prof. Dr. F. Farinati, Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Padova, Italy,

DOI: 10.1016/j.dld.2021.08.025

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