Surveillance for hepatocellular carcinoma with a 3-months interval in "extremely high-risk" patients does not further improve survival.
Cancer stage
Hepatocellular carcinoma
Surveillance interval
Survival
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
12
05
2021
revised:
26
08
2021
accepted:
31
08
2021
pubmed:
29
9
2021
medline:
30
6
2022
entrez:
28
9
2021
Statut:
ppublish
Résumé
An enhanced surveillance schedule has been proposed for cirrhotics with viral etiology, who are considered at extremely high-risk of hepatocellular carcinoma (HCC). We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival. Data of 777 HBV and HCV 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. 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 months [45.9-64.0]) was not significantly different from the observed (47.0 months [35.0-58.9]; p = 0.43) and adjusted (44.9 months [33.4-56.4]; p = 0.30) survival of 3MS patients. A propensity score analysis confirmed the absence of a survival advantage for 3MS patients. A tightening of surveillance schedule does not increase the diagnosis of early-stage tumors, the feasibility of curative treatments and the survival. Therefore, we should maintain the 6-months interval in the surveillance of viral cirrhotics.
Sections du résumé
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
We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival.
METHODS
Data of 777 HBV and HCV 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 months [45.9-64.0]) was not significantly different from the observed (47.0 months [35.0-58.9]; p = 0.43) and adjusted (44.9 months [33.4-56.4]; 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, we should maintain the 6-months interval in the surveillance of viral cirrhotics.
Identifiants
pubmed: 34580038
pii: S1590-8658(21)00766-0
doi: 10.1016/j.dld.2021.08.025
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
927-936Investigateurs
Maurizio Biselli
(M)
Paolo Caraceni
(P)
Francesca Garuti
(F)
Annagiulia Gramenzi
(A)
Andrea Neri
(A)
Valentina Santi
(V)
Fabio Piscaglia
(F)
Francesco Tovoli
(F)
Alessandro Granito
(A)
Luca Muratori
(L)
Francesca Benevento
(F)
Elton Dajti
(E)
Giovanni Marasco
(G)
Federico Ravaioli
(F)
Alberta Cappelli
(A)
Rita Golfieri
(R)
Cristina Mosconi
(C)
Matteo Renzulli
(M)
Angela Imondi
(A)
Anna Sartori
(A)
Barbara Penzo
(B)
Elisa Pinto
(E)
Ester Marina Cela
(EM)
Antonio Facciorusso
(A)
Valentina Cacciato
(V)
Edoardo Casagrande
(E)
Alessandro Moscatelli
(A)
Gaia Pellegatta
(G)
Nicoletta De Matthaeis
(N)
Gloria Allegrini
(G)
Valentina Lauria
(V)
Giorgia Ghittoni
(G)
Giorgio Pelecca
(G)
Fabrizio Chegai
(F)
Fabio Coratella
(F)
Mariano Ortenzi
(M)
Gabriele Missale
(G)
Alessandro Inno
(A)
Fabiana Marchetti
(F)
Anita Busacca
(A)
Giuseppe Cabibbo
(G)
Calogero Cammà
(C)
Vincenzo Di Martino
(V)
Giacomo Emanuele Maria Rizzo
(GEM)
Maria Stella Franzè
(MS)
Carlo Saitta
(C)
Assunta Sauchella
(A)
Vittoria Bevilacqua
(V)
Alberto Borghi
(A)
Andrea Casadei Gardini
(A)
Fabio Conti
(F)
Anna Chiara Dall'aglio
(AC)
Giorgio Ercolani
(G)
Federica Mirici
(F)
Claudia Campani
(C)
Chiara Di Bonaventura
(C)
Stefano Gitto
(S)
Pietro Coccoli
(P)
Antonio Malerba
(A)
Maria Guarino
(M)
Maurizia Brunetto
(M)
Veronica Romagnoli
(V)
Informations de copyright
Copyright © 2021. Published by Elsevier Ltd.