Surveillance for hepatocellular carcinoma is associated with increased survival: Results from a large cohort in the Netherlands

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• 作者：Suzanne van Meer¹ ; Robert A. de Man² ; Minneke J. Coenraad³ ; Dave Sprengers² ; Karin M.J. van Nieuwkerk⁴ ; Heinz-Josef Klü ; mpen⁵ ; Peter L.M. Jansen⁶ ; Jan N.M. IJzermans⁷ ; Martijn G.H. van Oijen¹ ; Peter D. Siersema¹ ; Karel J. van Erpecum¹ ; ^{k.j.vanerpecum@umcutrecht.nl" class="auth_mail" title="E-mail the corresponding author}
• 关键词：HCC ; Hepatocellular carcinoma ; HBV ; Hepatitis B virus infection ; HCV ; Hepatitis C virus infection ; US ; Ultrasound ; AFP ; Alpha&ndash ; fetoprotein ; BCLC ; Barcelona Clinic Liver Cancer ; RFA ; Radiofrequency ablation ; TACE ; Transarterial chemoembolization ; TARE ; Transarterial radioembolization ; HR ; Hazard ratio ; PS ; Performance score
• 刊名：Journal of Hepatology
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：63
• 期：5
• 页码：1156-1163
• 全文大小：750 K

文摘

Effectiveness of surveillance for hepatocellular carcinoma is controversial. We here explore its effects in “real life” clinical practice.

c_2">Methods

Patients with hepatocellular carcinoma diagnosed in the period 2005–2012 in five Dutch academic centers were evaluated. Surveillance was defined as 猢? screening tests during three preceding years and at least one radiologic imaging test within 18 months before diagnosis.

c_3">Results

295 (27%) of 1074 cases underwent surveillance. Median time interval between last negative radiologic imaging and hepatocellular carcinoma diagnosis was 7.5 months. In the surveillance group, cirrhosis (97% vs. 60%, p <0.001) and viral hepatitis were more frequent, and non-alcoholic fatty liver disease or absence of risk factors less frequent.

In case of surveillance, tumor size was significantly smaller (2.7 vs. 6.0 cm), with lower alpha–fetoprotein levels (16 vs. 44 渭g/L), earlier tumor stage (BCLC 0 and A combined: 61% vs. 21%) and resection/transplantation (34% vs. 25%) or radiofrequency ablation (23% vs. 7%) more often applied, with significantly higher 1-, 3-, and 5-year survival rates.

Survival benefit by surveillance remained significant after adjustment for lead-time bias based on assumed tumor doubling time of 90 days, but not with doubling time of 猢?20 days. In multivariate analysis, surveillance was an independent predictor for mortality (for interval 猢? respectively >9 months: adjusted HRs 0.51 and 0.50, 95% confidence intervals: 0.39–0.67 and 0.37–0.69).

c_4">Conclusions

Surveillance for hepatocellular carcinoma was associated with smaller tumor size, earlier tumor stage, with an impact on therapeutic strategy and was an independent predictor of survival.