Liver and Bile
Dig Liver Dis. 2022;54(7):927–36
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.