Skip to main content

Advertisement

SpringerLink
Log in

Cirrhosis Patients with Nonalcoholic Steatohepatitis Are Significantly Less Likely to Receive Surveillance for Hepatocellular Carcinoma

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background

Disparities in receipt of hepatocellular carcinoma (HCC) surveillance contribute to disparities in overall survival outcomes.

Aim

We aim to evaluate disparities in receipt of routine HCC surveillance among patients with cirrhosis in a large urban safety-net hospital.

Methods

Consecutive adults (age ≥ 18) with cirrhosis from July 1, 2014, to December 31, 2015, were retrospectively evaluated to determine rates of receiving appropriate HCC surveillance within 6 months and 1 year after diagnosis of cirrhosis. Rates of HCC surveillance were stratified by sex, race/ethnicity, and liver disease etiology. Multivariate Cox proportional hazards models were utilized to evaluate for predictors of receiving appropriate HCC surveillance.

Results

Among 157 cirrhosis patients enrolled [hepatitis C virus (HCV): 29.9%, hepatitis B virus: 13.4%, alcoholic cirrhosis: 44.6%, nonalcoholic steatohepatitis (NASH): 8.9%], mean age of cirrhosis diagnosis was 53.8 ± 9.0 years. Among these patients, 49% received (n = 77) HCC surveillance within 6 months and 78% (n = 123) were surveyed within 1 year of cirrhosis diagnosis. On multivariate analyses, patients with NASH cirrhosis were significantly less likely to receive HCC surveillance compared with chronic HCV cirrhosis patients (HR 0.44, 95% CI 0.19–0.99, p < 0.05). No significant sex-specific or race/ethnicity-specific disparities in receipt of HCC surveillance were observed.

Conclusion

Among a diverse safety-net hospital population, sub-optimal HCC surveillance rates were observed: Only 49% of cirrhosis patients received HCC surveillance within 6 months, and 78% of cirrhosis patients received HCC surveillance within 1 year. Differences in rates of HCC screening by liver disease etiology were observed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

AASLD:

American association for the study of liver disease

AFP:

Alpha-fetoprotein

EASL:

European association for the study of the liver

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

MELD:

Model for end stage liver disease

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

References

  1. Parkin DM. Global cancer statistics in the year 2000. Lancet Oncol.. 2001;2:533–543.

    Article  CAS  PubMed  Google Scholar 

  2. El-Serag HB. Hepatocellular carcinoma. N Engl J Med.. 2011;365:1118–1127.

    Article  CAS  PubMed  Google Scholar 

  3. Liu JH, Chen PW, Asch SM, Busuttil RW, Ko CY. Surgery for hepatocellular carcinoma: does it improve survival? Ann Surg Oncol.. 2004;11:298–303.

    Article  PubMed  Google Scholar 

  4. Njei B, Rotman Y, Ditah I, Lim JK. Emerging trends in hepatocellular carcinoma incidence and mortality. Hepatology. 2015;61:191–199.

    Article  PubMed  Google Scholar 

  5. Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology. 2002;35:519–524.

    Article  PubMed  Google Scholar 

  6. Singal AG, Pillai A, Tiro J. Early detection, curative treatment, and survival rates for hepatocellular carcinoma surveillance in patients with cirrhosis: a meta-analysis. PLoS Med.. 2014;11:e1001624.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–1236.

    Article  PubMed  Google Scholar 

  8. European Association For The Study Of The Liver. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–943.

    Article  Google Scholar 

  9. Kubota K, Ina H, Okada Y, Irie T. Growth rate of primary single hepatocellular carcinoma: determining optimal screening interval with contrast enhanced computed tomography. Dig Dis Sci. 2003;48:581–586. doi:10.1023/A:1022505203786.

    Article  PubMed  Google Scholar 

  10. Okada S, Okazaki N, Nose H, et al. Follow-up examination schedule of postoperative HCC patients based on tumor volume doubling time. Hepatogastroenterology. 1993;40:311–315.

    CAS  PubMed  Google Scholar 

  11. Leykum LK, El-Serag HB, Cornell J, Papadopoulos KP. Screening for hepatocellular carcinoma among veterans with hepatitis C on disease stage, treatment received, and survival. Clin Gastroenterol Hepatol.. 2007;5:508–512.

    Article  PubMed  Google Scholar 

  12. Davila JA, Morgan RO, Richardson PA, Du XL, McGlynn KA, El-Serag HB. Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States. Hepatology. 2010;52:132–141.

    Article  PubMed  Google Scholar 

  13. Davila JA, Weston A, Smalley W, El-Serag HB. Utilization of screening for hepatocellular carcinoma in the United States. J Clin Gastroenterol.. 2007;41:777–782.

    Article  PubMed  Google Scholar 

  14. Venook AP, Papandreou C, Furuse J, de Guevara LL. The incidence and epidemiology of hepatocellular carcinoma: a global and regional perspective. Oncologist. 2010;15:5–13.

    Article  PubMed  Google Scholar 

  15. Patwardhan V, Paul S, Corey KE, et al. Hepatocellular carcinoma screening rates vary by etiology of cirrhosis and specialist involvement. Dig Dis Sci. 2011;56:3316–3322. doi:10.1007/s10620-011-1836-2.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol.. 2004;130:417–422.

    PubMed  Google Scholar 

  17. Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–1022.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mittal S, Sada YH, El-Serag HB, et al. Temporal trends of nonalcoholic fatty liver disease-related hepatocellular carcinoma in the veteran affairs population. Clin Gastroenterol Hepatol.. 2015;13:e591.

    Article  Google Scholar 

  19. Goldberg DS, Taddei TH, Serper M, et al. Identifying barriers to hepatocellular carcinoma surveillance in a national sample of patients with cirrhosis. Hepatology. 2017;65:864–874.

    Article  PubMed  Google Scholar 

  20. Farvardin S, Patel J, Khambaty M, et al. Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis. Hepatology. 2017;65:875–884.

    Article  PubMed  Google Scholar 

  21. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis in adults. Aliment Pharmacol Ther.. 2011;34:274–285.

    Article  CAS  PubMed  Google Scholar 

  22. Younossi ZM, Reyes MJ, Mishra A, Mehta R, Henry L. Systematic review with meta-analysis: nonalcoholic steatohepatitis: a case for personalised treatment based on pathogenic targets. Aliment Pharmacol Ther.. 2014;39:3–14.

    Article  CAS  PubMed  Google Scholar 

  23. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55:2005–2023.

    Article  PubMed  Google Scholar 

  24. Rinella ME. Nonalcoholic fatty liver disease: a systematic review. Jama. 2015;313:2263–2273.

    Article  CAS  PubMed  Google Scholar 

  25. Younossi ZM, Otgonsuren M, Henry L, et al. Association of nonalcoholic fatty liver disease (NAFLD) with hepatocellular carcinoma (HCC) in the United States from 2004 to 2009. Hepatology. 2015;62:1723–1730.

    Article  CAS  PubMed  Google Scholar 

  26. Del Poggio P, Olmi S, Ciccarese F, et al. Factors that affect efficacy of ultrasound surveillance for early stage hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol.. 2014;12:1927–1933.

    Article  PubMed  Google Scholar 

  27. Gopal P, Yopp AC, Waljee AK, et al. Factors that affect accuracy of alpha-fetoprotein test in detection of hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol.. 2014;12:870–877.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Alameda Health System – Highland Hospital, Oakland, CA, USA

    Hesam Tavakoli & Ann Robinson

  2. Division of Gastroenterology and Hepatology, Alameda Health System – Highland Hospital, 1411 East 31st Street, Highland Hospital – Highland Care Pavilion 5th Floor, Endoscopy Unit, Oakland, CA, 94602, USA

    Benny Liu, Taft Bhuket & Robert J. Wong

  3. Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA

    Zobair Younossi

  4. Departments of Medicine and Surgery, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA, USA

    Sammy Saab

  5. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA

    Aijaz Ahmed

Authors
  1. Hesam Tavakoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ann Robinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benny Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Taft Bhuket
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zobair Younossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sammy Saab
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aijaz Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Robert J. Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert J. Wong.

Ethics declarations

Conflict of interest

Hesam Tavakoli: None. Ann Robinson: None. Benny Liu: None. Taft Bhuket: None. Zobair Younossi: Consultant—Gilead, Abbvie, Bristol Myers Squibb, Glaxo Smith Kline, Tobira. Sammy Saab: Consultant and speaker’s bureau—Gilead and Bristol Myers Squibb. Aijaz Ahmed: Consultant, advisory board, and research grants—Gilead. Robert Wong: Consultant, advisory board, research grants, and speaker’s bureau—Gilead.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tavakoli, H., Robinson, A., Liu, B. et al. Cirrhosis Patients with Nonalcoholic Steatohepatitis Are Significantly Less Likely to Receive Surveillance for Hepatocellular Carcinoma. Dig Dis Sci 62, 2174–2181 (2017). https://doi.org/10.1007/s10620-017-4595-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-017-4595-x

Keywords

Search

Navigation