RECENT findings from a retrospective cohort study demonstrate that hepatocellular carcinoma (HCC) screening in patients with cirrhosis liver disease is associated with improved early-stage tumour detection and survival, persisting after lead-time and length-time bias adjustment.
HCC is the fourth leading cause of cancer-related deaths globally. Eligibility for curative therapy is primarily determined by the tumour stage, with early-stage curative treatment linked to 5-year survival rates nearing 70%. In patients classified as high-risk, including those with cirrhosis, the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) recommend HCC screening using ultrasonography with or without α-fetoprotein. However, a previous case-control study’s inability to identify an association between screening and reduced HCC-related mortality in patients with cirrhosis has contributed to controversy surrounding screening. Therefore, evaluating the impact of HCC screening on patient outcomes is important in implementing cancer screening programmes.
The retrospective cohort was comprised of 1,313 patients diagnosed with HCC at University of Texas Southwestern Medical Center and Parkland Health, Dallas, USA, from January 2008–December 2022. The study’s primary objective was to characterise the clinical benefits of HCC screening, correcting for both lead-time and length-time biases, in a diverse cohort of high-risk patients. Cox regression analysis was used to characterise survival differences between screen-detected and non-screen-detected HCC, while the Duffy parametric formula was used to calculate lead-time and length-time adjustments.
Patients undergoing screening had a higher likelihood of early-stage HCC tumours, compared to the non-screening group (70.7% versus 45.7%). Nevertheless, response to curative treatment was similar in screen-detected patients versus incidental and symptomatic tumours, with response rates exceeding 80%. The median survival for screen-detected tumours reached 37 months, compared to 19 months for incidental or symptomatic tumours. The improved HCC-related mortality in the screen-detected patients persisted after adjustments for lead-time bias. Furthermore, results showed that 3- and 5-year survival rates were higher for patients with screen-detected HCC than for exploratory analyses, even after adjustment for length-time bias.
The findings from this study led the authors to emphasise the significance of implementing HCC screening in clinics and the continued need for studies evaluating the benefits and harms of HCC screening.
Reference
Daher D et al. Hepatocellular carcinoma screening in a contemporary cohort of at-risk patients. JAMA Netw Open. 2024;7(4):e248755.
