Screening for hepatocellular carcinoma in chronic liver disease: a systematic review

Area of Science:

• Hepatology
• Oncology
• Diagnostic Imaging

Background:

• Guidelines recommend routine hepatocellular carcinoma (HCC) screening for high-risk individuals.
• The evidence supporting these screening recommendations is not well-established.
• This review focuses on patients with chronic liver disease.

Purpose of the Study:

• To evaluate the benefits and harms of HCC screening in patients with chronic liver disease.
• To assess the impact of screening on mortality and adverse events.

Main Methods:

• Systematic review of MEDLINE, PsycINFO, Cochrane databases, and ClinicalTrials.gov up to 2014.
• Inclusion of English-language trials and observational studies comparing screening versus no screening.
• Assessment of study quality and strength of evidence using published criteria.

Main Results:

• The overall strength of evidence for HCC screening effectiveness was very low.
• One trial suggested decreased HCC mortality with ultrasonographic screening, but had methodological flaws.
• Observational studies showed earlier-stage HCC detection in screened patients, but mortality benefits were confounded by bias.

Conclusions:

• The evidence base for HCC screening is limited by methodological issues and a lack of robust trials.
• Current evidence does not definitively confirm a survival advantage for systematic HCC screening over clinical diagnosis.
• Harms associated with HCC screening were not adequately studied.