Benefits and Harms of Hepatocellular Carcinoma Surveillance in a Prospective Cohort of Patients With Cirrhosis
| Autor: | Joseph Obi, Jorge A. Marrero, Neehar D. Parikh, Sruthi Patibandla, Adam C. Yopp, Hannah Fullington, Amit G. Singal |
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| Rok vydání: | 2020 |
| Předmět: |
Liver Cirrhosis
medicine.medical_specialty Cirrhosis Carcinoma Hepatocellular Article 03 medical and health sciences 0302 clinical medicine Internal medicine Cancer screening medicine Humans Prospective Studies Prospective cohort study Early Detection of Cancer Hepatology business.industry Liver Neoplasms Gastroenterology medicine.disease BCLC Stage Clinical trial 030220 oncology & carcinogenesis Hepatocellular carcinoma Cohort 030211 gastroenterology & hepatology business Liver cancer |
| Zdroj: | Clin Gastroenterol Hepatol |
| ISSN: | 1542-7714 |
| Popis: | Background & Aims The value of a cancer screening programs is defined by its balance of benefits and harms; however, there are few data evaluating both attributes for hepatocellular carcinoma (HCC) surveillance. We aimed to characterize benefits and harms of HCC surveillance in a large prospective cohort of patients with cirrhosis. Methods We conducted a secondary analysis of a clinical trial evaluating HCC surveillance among patients with cirrhosis at a safety-net health system enrolled between December 2014 and July 2015. We quantified surveillance-related benefits, defined as early HCC detection and curative treatment receipt, and physical harms, defined as diagnostic procedures for false positive or indeterminate results, over an 18-month period. Results Of 614 cirrhosis patients with ≥1 surveillance exam, abnormal results were observed in 118 (19.2%) patients. Twenty-six patients developed HCC during follow-up, of whom 16 (61.5%) were detected by surveillance. The proportion of HCC detected at BCLC stage 0/A (62.5% vs 50%, p = .69) and who underwent curative treatment (43.8% vs. 40.0%, p = 1.0) did not significantly differ between surveillance-detected patients and those diagnosed incidentally/symptomatically. Physical harms were observed in 54 (8.8%) patients who underwent surveillance – most of mild severity with only 1 diagnostic CT or MRI and none undergoing invasive testing such as biopsy. Incidental findings on follow-up imaging were found in 40 (6.5%) patients —23 of low clinical importance and 17 medium clinical importance. Conclusions In our cohort of patients with cirrhosis, HCC surveillance was associated with high early tumor detection and minimal physical harms. |
| Databáze: | OpenAIRE |
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