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Performance and effectiveness of hepatocellular carcinoma screening in individuals with HBsAg seropositivity in
Hongmei Zeng1, Maomao Cao2, Changfa Xia2
1National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Insights
Annual screening for hepatocellular carcinoma (HCC) in individuals with hepatitis B virus infection significantly improves survival. This multicenter study in China demonstrates the real-world effectiveness of early HCC detection through regular screening.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Hepatocellular carcinoma (HCC) surveillance is recommended for at-risk populations, including those with hepatitis B virus (HBV) infection.
- The effectiveness and survival benefits of annual HCC screening in a Chinese population remain under-evaluated in multicenter prospective studies.
Purpose of the Study:
- To evaluate the performance and survival benefits of annual HCC screening in a large Chinese cohort with HBV infection.
- To assess the real-world feasibility and effectiveness of early HCC detection through community-based screening programs.
Main Methods:
- A multicenter prospective study involving 14,426 participants with hepatitis B surface antigen seropositivity.
- Annual screening using ultrasonography and serum alpha-fetoprotein assays over four rounds (2017-2021).
- Statistical analysis included correction for lead-time and length-time biases, and a meta-analysis.
Main Results:
- Adjusted hazard ratios for death in screen-detected HCC were 0.74 (prevalent rounds) and 0.52 (incident rounds), indicating improved survival.
- Meta-analysis confirmed that HCC screening is associated with improved survival after adjusting for lead-time bias.
- Demonstrated feasibility and effectiveness of annual HCC screening in community settings for early HCC detection.
Conclusions:
- Annual HCC screening in HBV-infected individuals in China is feasible and effective for early detection.
- Regular screening significantly improves survival rates for hepatocellular carcinoma.
- Findings support the implementation of community-based annual HCC screening programs to enhance patient outcomes.
Abstract:
Current guidelines recommend hepatocellular carcinoma (HCC) surveillance for at-risk individuals, including individuals with hepatitis B virus infection. However, the performance and survival benefits of annual screening have not been evaluated through multicenter prospective studies in a Chinese population. Between 2017 and 2021, we included 14,426 participants with hepatitis B surface antigen seropositivity in an annual HCC screening study in China using a multicenter prospective design with ultrasonography and serum alpha-fetoprotein. After four rounds of screening and follow-up, the adjusted hazard ratios of death after correction for lead-time and length-time biases for screen-detected cancers at the prevalent and incident rounds were 0.74 (95% confidence interval = 0.60-0.91) and 0.52 (95% confidence interval = 0.40-0.68), respectively. A meta-analysis demonstrated that HCC screening was associated with improved survival after adjusting for lead-time bias. Our findings highlight the 'real-world' feasibility and effectiveness of annual HCC screening in community settings for the early detection of HCC and to improve survival.
