Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survival

Background & Aims

The current guidelines recommend the surveillance of cirrhotic patients for early diagnosis of hepatocellular carcinoma (HCC), based on liver ultrasonography repetition at either 6 or 12month intervals, since there is no compelling evidence of superiority of the more stringent program. This study aimed at comparing cancer stage, treatment applicability, and survival between patients on semiannual or annual surveillance.

Methods

We analyzed the clinical records of 649 HCC patients in Child-Pugh class A or B, observed in ITA.LI.CA centers. HCC was detected in 510 patients submitted to semiannual surveillance (Group 1) and in 139 submitted to annual surveillance (Group 2). In Group 1 the survival was presented as observed and corrected for the lead time.

Results

The cancer stage was less severe in Group 1 than in Group 2 (p<0.001), with more single tiny (⩽2cm) and less advanced tumors. Treatment applicability was improved by the semiannual program (p=0.020). The median observed survival was 45months (95% CI 40.0–50.0) in Group 1 and 30months (95% CI 24.0–36.0) in Group 2 (p=0.001). The median corrected survival of Group 1 was 40.3months (95% CI 34.9–45.7) (p=0.028 with respect to the observed survival of Group 2). Age, platelet count, α-fetoprotein, Child-Pugh class, cancer stage, and hepatocellular carcinoma treatment were independent prognostic factors.

Conclusions

Semiannual surveillance increases the detection rate of very early hepatocellular carcinomas and reduces the number of advanced tumors as compared to the annual program. This translates into a greater applicability of effective treatments and into a better prognosis.

Abbreviations: HCC, hepatocellular carcinoma, HBsAg, hepatitis B surface antigen, US, ultrasonographies, AASLD, American Association of the Study of the Liver Disease, C-P, Child-Pugh, ITA.LI.CA, Italian Liver Cancer, AFP, α-fetoprotein, HCV, hepatitis C virus, HBV, hepatitis B virus, CT, computed tomography, MRI, magnetic resonance imaging, CEUS, contrast enhanced–US, V0, without macrovascular invasion, L0, without lymph-node invasion, M0, without distant metastases, PEI, percutaneous ethanol injection, RF, radiofrequency thermoablation, TACE, transarterial chemoembolization, ALT, alanine aminotranspherase, CI, confidence interval, DT, doubling time, OLT, orthotopic liver transplantation

Keywords: Hepatocellular carcinoma, Cirrhosis, Diagnosis, Surveillance interval, Cancer stage, Survival