Liver and Bile
Hepatology. 2024;79(4):813–28
The clinical and financial burden of non-hepatocellular carcinoma focal lesions detected during the surveillance of patients with cirrhosis
Background and aims: Hepatocellular carcinoma (HCC) surveillance is challenged by the detection of hepatic focal lesions (HFLs) of other types. This study aimed to describe the incidence, characteristics, outcomes, and costs of non-HCC HFLs detected during surveillance.
Approach and results: The authors retrospectively analyzed non-standardized work-up performed in French patients included in HCC surveillance programs recruited in 57 French tertiary centers (ANRS CirVir and CIRRAL cohorts, HCC 2000 trial). The overall cost of work-up was evaluated, with an estimation of an average cost per patient for the entire population and per lesion detected. A total of 3295 patients were followed up for 59.8 months, 391 (11.9%) patients developed HCCs (5-year incidence: 12.1%), and 633 (19.2%) developed non-HCC HFLs (5-year incidence: 21.8%). Characterization of non-HCC HFLs required a median additional of 0.7 exams per year. A total of 11.8% of non-HCC HFLs were not confirmed on recall procedures, and 19.6% of non-HCC HFLs remained undetermined. A definite diagnosis of benign liver lesions was made in 65.1%, and malignant tumors were diagnosed in 3.5%. The survival of patients with benign or undetermined non-HCC HFLs was similar to that of patients who never developed any HFL (5-year survival: 92% vs. 88%, p = 0.07). The average cost of the diagnostic work-up was 1087 Euro for non-HCC HFL and 1572 Euro for HCC.
Conclusions: Non-hepatocellular carcinoma hepatic focal lesions are frequently detected in patients with cirrhosis, and do not impact prognosis, but trigger substantial costs. This burden must be considered in cost-effectiveness analyses of future personalized surveillance strategies.