Hepatocellular carcinoma surveillance, early detection and survival in a privately insured US cohort

Semiannual hepatocellular carcinoma (HCC) surveillance is recommended in patients with cirrhosis; however, recent studies have raised questions over its utility. We investigated the impact of surveillance on early detection and survival in a nationally representative database.

We included patients with cirrhosis and HCC from the Optum database (2001-2015) with >6 months of follow-up between cirrhosis and HCC diagnoses. Surveillance adherence was defined as proportion of time covered (PTC), with each 6-month period after abdominal imaging defined as 'covered'. To determine the association between surveillance and mortality, we compared PTC between fatal and non-fatal HCC.

Of 1001 patients with cirrhosis and HCC, 256 died with median follow-up 30 months. Median PTC by any imaging was greater in early-stage vs late-stage HCC (43.6% vs 37.4%, P = .003) and non-fatal vs fatal HCC (40.8% vs 34.3%, P = .001). In multivariable analyses, each 10% increase in PTC was associated with increased early HCC detection (OR 1.07, 95% CI 1.01-1.12) and decreased mortality (HR 0.95; 95% CI 0.90-1.00). On subgroup analysis, PTC by CT/MRI was associated with early tumour detection and decreased mortality; however, PTC by ultrasound was only associated with early detection but not decreased mortality. These findings were robust across sensitivity analyses.

In a US cohort of privately insured HCC patients, PTC by any imaging modality was associated with increased early detection and decreased mortality. Continued evaluation of HCC surveillance strategies and effectiveness is warranted.