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Surveillance for Hepatocellular Carcinoma: Does the Place Where Ultrasound Is Performed Impact Its Effectiveness?

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Abstract

Background

Biannual ultrasound (US) is recommended as the clinical screening tool for hepatocellular carcinoma (HCC). The effectiveness of surveillance according to the place where US is performed has not been previously reported.

Aims

To compare the effectiveness of US performed in the center responsible for follow-up as opposed to US proceeding from centers other than that of follow-up.

Methods

This is a multicenter cohort study from Argentina. The last US was categorized as done in the same center or done in a different center from the institution of the patient’s follow-up. Surveillance failure was defined as HCC diagnosis not meeting Barcelona Clinic Liver Cancer (BCLC) stages 0-A or when no nodules were observed at HCC diagnosis.

Results

From 533 patients with HCC, 62.4% were under routine surveillance with a surveillance failure of 38.8%. After adjusting for a propensity score matching, BCLC stage and lead-time survival bias, surveillance was associated with a significant survival benefit [HR of 0.51 (CI 0.38; 0.69)]. Among patients under routine surveillance (n = 345), last US was performed in the same center in 51.6% and in a different center in 48.4%. Similar rates of surveillance failure were observed between US done in the same or in a different center (32% vs. 26.3%; P = 0.25). Survival was not significantly different between both surveillance modalities [HR 0.79 (CI 0.53; 1.20)].

Conclusions

Routine surveillance for HCC in the daily practice improved survival either when performed in the same center or in a different center from that of patient’s follow-up.

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Abbreviations

AFP:

Alpha-fetoprotein

BSC:

Best supportive care

CI:

Confidence interval

CT:

Computerized tomography

ECOG:

Eastern Cooperative Oncology Group

HCC:

Hepatocellular carcinoma

HR:

Hazard ratio

IQR:

Interquartile range

LT:

Liver transplantation

LR:

Liver resection

MRI:

Magnetic resonance imaging

NAFL:

Nonalcoholic fatty liver

PEI:

Percutaneous ethanol injection

RFA:

Radiofrequency ablation

TACE:

Transarterial chemoembolization

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Acknowledgments

We thank the Latin American Liver Research, Education and Awareness Network (LALREAN) for the support of this research.

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Authors and Affiliations

  1. Hepatology and Liver Transplant Unit, Facultad de Medicina, Hospital Universitario Austral, Universidad Austral, Av. Presidente Perón 1500, B1629HJ, Pilar, Buenos Aires, Argentina

    Federico Piñero, Ezequiel Ridruejo & Marcelo Silva

  2. Sección Hepatología, Departamento de Investigación, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Sebastián Marciano, Carla Bermúdez & Adrián Gadano

  3. Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina

    Ezequiel Ridruejo

  4. Hospital Alemán de Buenos Aires, Buenos Aires, Argentina

    Margarita Anders & Lucas McCormack

  5. Hospital Británico de Buenos Aires, Buenos Aires, Argentina

    Nora Fernández & Luis Colombato

  6. Hospital Udaondo, Buenos Aires, Argentina

    Carlos Miguez & Gustavo Romero

  7. Clínica de Nefrología de Santa Fe, Santa Fe, Argentina

    Luis Gaite

  8. Hospital del Centenario, Rosario, Santa Fe, Argentina

    Yanina Zambelo & Virginia Reggiardo

  9. Hospital Privado de Córdoba, Córdoba, Argentina

    Alina Zerega

  10. Hospital G Rawson, San Juan, Argentina

    Jorge Silva & Carlos Rosales

  11. Sanatorio Trinidad San Isidro, Buenos Aires, Argentina

    Federico Piñero

  12. Clínica Privada San Fernando, Buenos Aires, Argentina

    Federico Piñero

  13. Centro Especialidades Medicas Ambulatorias (CEMA), Mar del Plata, Buenos Aires, Argentina

    Claudia D’Amico

  14. Hospital Ramos Mejía, Ciudad de Buenos Aires, Argentina

    Beatriz Ameigeiras

  15. Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina

    Fernando Rubinstein

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  1. Federico Piñero
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Corresponding author

Correspondence to Federico Piñero.

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Conflict of interest

The authors of this manuscript have no conflicts of interest to disclose as described by the Digestive Diseases and Sciences.

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This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10620_2018_5390_MOESM1_ESM.tiff

Supplementary Figure 1. Receiving Operator Curve from the final logistic regression model assessing probability of surveillance (TIFF 3072 kb)

10620_2018_5390_MOESM2_ESM.tiff

Supplementary Figure 2. Proportional hazard assumption and observed versus predicted curves from an adjusted survival model regarding surveillance (TIFF 3072 kb)

Supplementary material 3 (TIFF 3072 kb)

Supplementary material 4 (DOCX 18 kb)

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Piñero, F., Rubinstein, F., Marciano, S. et al. Surveillance for Hepatocellular Carcinoma: Does the Place Where Ultrasound Is Performed Impact Its Effectiveness?. Dig Dis Sci 64, 718–728 (2019). https://doi.org/10.1007/s10620-018-5390-z

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  • DOI: https://doi.org/10.1007/s10620-018-5390-z

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