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Incidence and risk factors for surveillance failure in patients with regular hepatocellular carcinoma surveillance

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Abstract

Background

Initial presentation of hepatocellular carcinoma (HCC) at an advanced stage in patients under a regular surveillance program is a devastating problem.

Aims

We assessed the prevalence and factors associated with this surveillance failure.

Methods

A total of 304 HCC patients who received regular surveillance were retrospectively reviewed. Surveillance failure was defined when the tumor was diagnosed at beyond the Milan criteria.

Results

Surveillance failure rate was 5.9 %. Macronodular cirrhosis (MC), ultrasonography-only surveillance (US-S) and infiltrative tumor type were independent factors associated with surveillance failure. The surveillance failure rate was higher in patients with MC (10.3 vs. 3.2 %, p = 0.022), US-S (14.6 vs. 4.3 %, p = 0.013) and when the tumor was infiltrative type (57.1 vs. 2.1 %, p < 0.001). Based on the two baseline factors (MC and US-S), the surveillance failure rates were 35.7, 6.8, 5.9 and 2.6 % for MC(+)/US-S(+), MC(+)/US-S(−), MC(−)/US-S(+) and MC(−)/US-S(−), respectively (p < 0.001).

Conclusion

The HCC surveillance failure was not rare in clinical practice. These data suggest that special attention for surveillance failure might be needed for patients with MC who receive US-S.

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Abbreviations

HCC:

Hepatocelular carcinoma

US:

Ultrasonography

US-S:

US-only surveillance

Alt-S:

Alternative surveillance

MC:

Macronodular cirrhosis

OR:

Odds ratio

CI:

Confidence interval

AASLD:

American Association for the Study of Liver Disease

EASL–EORTC:

European Association for the Study of the Liver–European Organisation for Research and Treatment of Cancer

APASL:

Asia Pacific Association for the Study of Liver Disease

KLCSG:

Korean Liver Cancer Study Group

AFP:

Alpha-fetoprotein

CT:

Computed tomography

MRI:

Magnetic resonance imaging

HBV:

Hepatitis B virus

NBNC:

Non-hepatitis B and non-hepatitis C

HCV:

Hepatitis C virus

AST:

Aspartate aminotransferase

ALT:

Alanine aminotransferase

PT:

Prothrombin time

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Acknowledgements

None.

Conflict of interest

Dong Hyun Sinn, Jieun Yi, Moon Seok Choi, Dongil Choi, Geum-Youn Gwak, Yong-Han Paik, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik and Byung Chul Yoo declare that they have no conflict of interest.

Financial support

None.

Compliance with ethical requirements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Institutional Review Board at Samsung Medical Center) and with the Helsinki Declaration of 1975, as revised in 2008. The requirement for informed consent was exempted by the Institutional Review Board because the study was based on the retrospective analysis of existing administrative and clinical data.

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Authors and Affiliations

  1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea

    Dong Hyun Sinn, Jieun Yi, Moon Seok Choi, Geum-Youn Gwak, Yong-Han Paik, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik & Byung Chul Yoo

  2. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Dongil Choi

  3. Department of Medicine, Sanggye Paik Hospital, Inje University School of Medicine, Seoul, South Korea

    Dong Hyun Sinn

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  1. Dong Hyun Sinn
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  2. Jieun Yi
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  3. Moon Seok Choi
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Corresponding author

Correspondence to Moon Seok Choi.

Additional information

Dong Hyun Sinn and Jieun Yi contributed equally to this study.

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Sinn, D.H., Yi, J., Choi, M.S. et al. Incidence and risk factors for surveillance failure in patients with regular hepatocellular carcinoma surveillance. Hepatol Int 7, 1010–1018 (2013). https://doi.org/10.1007/s12072-013-9462-z

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  • DOI: https://doi.org/10.1007/s12072-013-9462-z

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