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Hepatocellular Carcinoma Surveillance: Are We Utilizing It?
Nowlan Selvapatt1, Henry House, Ashley Brown
1*Imperial College †Imperial College Healthcare NHS Trust, London, UK.
Insights
Hepatocellular carcinoma (HCC) screening surveillance in UK cirrhosis patients is suboptimal, with only 65% receiving recommended 6-monthly ultrasounds. Early detection outcomes did not significantly differ between surveillance and incidental findings.
Area of Science:
- Hepatology
- Oncology
- Medical Imaging
Background:
- International guidelines advocate 6-monthly ultrasound surveillance for hepatocellular carcinoma (HCC) in cirrhosis patients.
- This study examines HCC screening adherence and outcomes in the UK's largest reported cirrhosis cohort.
Purpose of the Study:
- To evaluate the effectiveness of HCC surveillance in a large UK cirrhosis cohort.
- To identify predictors of surveillance adherence and analyze detection outcomes.
Main Methods:
- Retrospective review of cirrhotic patients eligible for HCC screening (n=898) at three London teaching hospitals.
- Categorization of patients into 'routine' or 'overdue' for surveillance, with analysis of non-adherence reasons.
- Univariate and multivariate analyses to identify clinical and sociodemographic surveillance predictors.
Main Results:
- Only 65% of eligible patients received HCC surveillance within the recommended 6-month period.
- Hepatocellular carcinoma (HCC) was detected in 6.8% of the cohort (61 cases).
- HCCs diagnosed via surveillance showed no significantly superior outcomes compared to incidentally detected cases.
Conclusions:
- HCC surveillance in this UK cirrhosis cohort is suboptimal and likely reflects broader national practice.
- Current surveillance strategies may not be improving patient outcomes significantly.
- Further research is needed to optimize HCC screening protocols for improved early detection and patient prognosis.
Background And Goals:
International guidelines recommend 6-monthly ultrasound scan surveillance in cirrhotic patients for hepatocellular carcinoma (HCC) screening. The aim of this study was to evaluate HCC surveillance and to provide the outcomes for the largest reported cirrhosis cohort in the United Kingdom.
Study:
We retrospectively reviewed all cirrhotic patients during the 6 months before April 1, 2014 at 3 teaching hospitals within the Imperial College Healthcare NHS Trust. All patients with cirrhosis eligible for HCC screening in the cohort were reviewed for evidence of screening and were characterized as either "routine" or "overdue." Reasons for failure to meet guidelines were identified in overdue patients. Univariate analyses were conducted to determine clinical and sociodemographic predictors of surveillance with a view to performing multivariate analysis.
Results:
Of the 898 patients eligible for inclusion, 65% patients had HCC surveillance performed in the past 6 months. During the observation period, 61 (6.8%) cases of HCC were detected. Thirty-eight were picked up on surveillance, 9 incidentally and in 14 cases it could not be determined from the notes. Within this cohort HCCs diagnosed on surveillance did not demonstrate significantly superior outcomes compared with those picked up incidentally.
Conclusions:
Surveillance of patients with cirrhosis within this cohort is suboptimal. Although disappointing at a local level, this is likely to be reflective of practice elsewhere.
