The clinical and financial burden of nonhepatocellular carcinoma focal lesions detected during the surveillance of patients with cirrhosis.
Journal
Hepatology (Baltimore, Md.)
ISSN: 1527-3350
Titre abrégé: Hepatology
Pays: United States
ID NLM: 8302946
Informations de publication
Date de publication:
01 Apr 2024
01 Apr 2024
Historique:
received:
16
05
2023
accepted:
01
09
2023
pubmed:
29
9
2023
medline:
29
9
2023
entrez:
29
9
2023
Statut:
ppublish
Résumé
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 HFL detected during surveillance. We retrospectively analyzed nonstandardized workup 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 workup 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 HFL 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 HFL 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 workup was 1087€ for non-HCC HFL and €1572 for HCC. Non-HCC HFLs 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.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
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 HFL detected during surveillance.
APPROACH AND RESULTS
RESULTS
We retrospectively analyzed nonstandardized workup 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 workup 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 HFL 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 HFL 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 workup was 1087€ for non-HCC HFL and €1572 for HCC.
CONCLUSIONS
CONCLUSIONS
Non-HCC HFLs 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.
Identifiants
pubmed: 37774387
doi: 10.1097/HEP.0000000000000615
pii: 01515467-990000000-00585
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
813-828Investigateurs
Pierre Nahon
(P)
Tarik Asselah
(T)
Dominique Guyader
(D)
Stanislas Pol
(S)
Hélène Fontaine
(H)
Georges-Philippe Pageaux
(GP)
Victor De Lédinghen
(V)
Denis Ouzan
(D)
Fabien Zoulim
(F)
Dominique Roulot
(D)
Albert Tran
(A)
Jean-Pierre Bronowicki
(JP)
Thomas Decaensi
(T)
Ghassan Riachi
(G)
Paul Calès
(P)
Jean-Marie Péron
(JM)
Laurent Alric
(L)
Marc Bourlière
(M)
Philippe Mathurin
(P)
Sebastien Dharancy
(S)
Jean-Frédéric Blanc
(JF)
Armand Abergel
(A)
Olivier Chazouillères
(O)
Ariane Mallat
(A)
Jean-Didier Grangé
(JD)
Pierre Attali
(P)
Louis d'Alteroche
(L)
Claire Wartelle
(C)
Thông Dao
(T)
Dominique Thabut
(D)
Christophe Pilette
(C)
Christine Silvain
(C)
Christos Christidis
(C)
Eric Nguyen-Khac
(E)
Brigitte Bernard-Chabert
(B)
Sophie Hillaire
(S)
Vincent Di Martino
(V)
Nathalie Ganne-Carrié
(N)
Cendrine Chaffaut
(C)
Isabelle Archambeaud
(I)
Louis d'Alteroche
(L)
Frédéric Oberti
(F)
Dominique Roulot
(D)
Christophe Moreno
(C)
Alexandre Louvet
(A)
Thông Dao
(T)
Romain Moirand
(R)
Odile Goria
(O)
Eric Nguyen-Khac
(E)
Nicolas Carbonell
(N)
Jean-Charles Duclos-Vallée
(JC)
Stanislas Pol
(S)
Victor de Ledinghen
(V)
Violaine Ozenne
(V)
Jean Henrion
(J)
Jean-Marie Péron
(JM)
Albert Tran
(A)
Gabriel Perlemuter
(G)
Xavier Amiot
(X)
Jean-Pierre Zarski
(JP)
Sylvie Chevret
(S)
Informations de copyright
Copyright © 2023 American Association for the Study of Liver Diseases.
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