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

  • Federico Piñero
  • Fernando Rubinstein
  • Sebastián Marciano
  • Nora Fernández
  • Jorge Silva
  • Yanina Zambelo
  • Margarita Anders
  • Alina Zerega
  • Ezequiel Ridruejo
  • Carlos Miguez
  • Beatriz Ameigeiras
  • Claudia D’Amico
  • Luis Gaite
  • Carla Bermúdez
  • Carlos Rosales
  • Gustavo Romero
  • Lucas McCormack
  • Virginia Reggiardo
  • Luis Colombato
  • Adrián Gadano
  • Marcelo Silva
Original Article



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.


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.


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.


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)].


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.


Carcinoma hepatocellular Surveillance Survival Risk adjustment 





Best supportive care


Confidence interval


Computerized tomography


Eastern Cooperative Oncology Group


Hepatocellular carcinoma


Hazard ratio


Interquartile range


Liver transplantation


Liver resection


Magnetic resonance imaging


Nonalcoholic fatty liver


Percutaneous ethanol injection


Radiofrequency ablation


Transarterial chemoembolization



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

Compliance with ethical standards

Conflict of interest

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

Financial support

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

Supplementary material

10620_2018_5390_MOESM1_ESM.tiff (3 mb)
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 (3 mb)
Supplementary Figure 2. Proportional hazard assumption and observed versus predicted curves from an adjusted survival model regarding surveillance (TIFF 3072 kb)
10620_2018_5390_MOESM3_ESM.tiff (3 mb)
Supplementary material 3 (TIFF 3072 kb)
10620_2018_5390_MOESM4_ESM.docx (19 kb)
Supplementary material 4 (DOCX 18 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Federico Piñero
    • 1
    • 11
    • 12
  • Fernando Rubinstein
    • 15
  • Sebastián Marciano
    • 2
  • Nora Fernández
    • 5
  • Jorge Silva
    • 10
  • Yanina Zambelo
    • 8
  • Margarita Anders
    • 4
  • Alina Zerega
    • 9
  • Ezequiel Ridruejo
    • 1
    • 3
  • Carlos Miguez
    • 6
  • Beatriz Ameigeiras
    • 14
  • Claudia D’Amico
    • 13
  • Luis Gaite
    • 7
  • Carla Bermúdez
    • 2
  • Carlos Rosales
    • 10
  • Gustavo Romero
    • 6
  • Lucas McCormack
    • 4
  • Virginia Reggiardo
    • 8
  • Luis Colombato
    • 5
  • Adrián Gadano
    • 2
  • Marcelo Silva
    • 1
  1. 1.Hepatology and Liver Transplant Unit, Facultad de Medicina, Hospital Universitario AustralUniversidad AustralPilarArgentina
  2. 2.Sección Hepatología, Departamento de InvestigaciónHospital Italiano de Buenos AiresBuenos AiresArgentina
  3. 3.Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC)Buenos AiresArgentina
  4. 4.Hospital Alemán de Buenos AiresBuenos AiresArgentina
  5. 5.Hospital Británico de Buenos AiresBuenos AiresArgentina
  6. 6.Hospital UdaondoBuenos AiresArgentina
  7. 7.Clínica de Nefrología de Santa FeSanta FeArgentina
  8. 8.Hospital del CentenarioRosarioArgentina
  9. 9.Hospital Privado de CórdobaCórdobaArgentina
  10. 10.Hospital G RawsonSan JuanArgentina
  11. 11.Sanatorio Trinidad San IsidroBuenos AiresArgentina
  12. 12.Clínica Privada San FernandoBuenos AiresArgentina
  13. 13.Centro Especialidades Medicas Ambulatorias (CEMA)Mar del PlataArgentina
  14. 14.Hospital Ramos MejíaCiudad de Buenos AiresArgentina
  15. 15.Instituto de Efectividad Clínica y Sanitaria (IECS)Buenos AiresArgentina

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