Improved Survival in Patients with Viral Hepatitis-Induced Hepatocellular Carcinoma Undergoing Recommended Abdominal Ultrasound Surveillance in Ontario: A Population-Based Retrospective Cohort Study
| Autor: | Craig C. Earle, Michael A. Campitelli, Eric M. Yoshida, Hla-Hla Thein, Latifa T. Yeung, Ahmad Zaheen |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Carcinoma Hepatocellular Population lcsh:Medicine Kaplan-Meier Estimate Hepatitis B Chronic Internal medicine Risk of mortality Medicine Humans education lcsh:Science Early Detection of Cancer Aged Proportional Hazards Models Retrospective Studies Ultrasonography Aged 80 and over Ontario education.field_of_study Multidisciplinary business.industry Proportional hazards model Hazard ratio lcsh:R Liver Neoplasms Retrospective cohort study Hepatitis C Chronic Middle Aged medicine.disease Surgery Cancer registry Hepatocellular carcinoma Epidemiological Monitoring Multivariate Analysis lcsh:Q Female business Viral hepatitis Research Article |
| Zdroj: | PLoS ONE PLoS ONE, Vol 10, Iss 9, p e0138907 (2015) |
| ISSN: | 1932-6203 |
| Popis: | The optimal schedule for ultrasonographic surveillance of patients with viral hepatitis for the detection of hepatocellular carcinoma (HCC) remains unclear owing to a lack of reliable studies. We examined the timing of ultrasonography in patients with viral hepatitis-induced HCC and its impact on survival and mortality risk while determining predictors of receiving surveillance before HCC diagnosis. A population-based retrospective cohort analysis of patients with viral hepatitis-induced HCC in Ontario between 2000 and 2010 was performed using data from the Ontario Cancer Registry linked health administrative data. HCC surveillance for 2 years preceding diagnosis was assigned as: i) ≥ 2 abdominal ultrasound screens annually; ii) 1 screen annually; iii) inconsistent screening; and iv) no screening. Survival rates were estimated using the Kaplan-Meier method and parametric models to correct for lead-time bias. Associations between HCC surveillance and the risk of mortality after diagnosis were examined using proportional-hazards regression adjusting for confounding factors. Overall, 1,483 patients with viral hepatitis-induced HCC were identified during the study period; 20.2% received ≥ 1 ultrasound screen annually (routine surveillance) for the 2 years preceding diagnosis. The 5-year survival of those receiving routine surveillance was 31.93% (95% CI: 25.77-38.24%) and 31.84% (95% CI: 25.69-38.14%) when corrected for lead-time bias (HCC sojourn time 70 days and 140 days, respectively). This is contrasted with 20.67% (95% CI: 16.86-24.74%) 5-year survival in those who did not undergo screening. In the fully adjusted model, compared to unscreened patients, routine surveillance was associated with a lower mortality risk and a hazard ratio of 0.76 (95% CI: 0.64-0.91) and 0.81 (95% CI: 0.68-0.97), corrected for the respective lead-time bias. Our findings suggest that routine ultrasonography in patients with viral hepatitis is associated with improved survival and reduced mortality risk in a population-based setting. The data emphasizes the importance of surveillance for timely intervention in HCC-diagnosed patients. |
| Databáze: | OpenAIRE |
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