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HCC-surveillance is associated with improved HCC-related mortality in patients with cirrhosis - a case-control study
Hannes Hegmar1,2, Bonnie Bengtsson2,3, Sofia Ullman2
1Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.
Insights
Hepatocellular carcinoma (HCC) surveillance via ultrasound screening is linked to reduced HCC-related mortality in cirrhosis patients. Early cirrhosis diagnosis is also crucial for improving survival outcomes.
Area of Science:
- Hepatology
- Oncology
- Gastroenterology
Background:
- Ultrasound screening for hepatocellular carcinoma (HCC) is guideline-recommended for cirrhosis patients.
- Conflicting data exists regarding HCC surveillance's impact on HCC-related mortality.
- This study aimed to validate findings on the association between HCC surveillance and mortality.
Purpose of the Study:
- To investigate the association between HCC surveillance and HCC-related mortality in patients with cirrhosis.
- To validate previous research suggesting no link between surveillance and reduced mortality.
Main Methods:
- A case-control study was conducted in Stockholm County, Sweden.
- Cases were patients who died from HCC (2004-2020); controls were matched patients without HCC death.
- An adjusted logistic regression model analyzed screening ultrasound exposure within two years of HCC diagnosis.
Main Results:
- 72 cases and 72 matched controls were analyzed after exclusions.
- An adjusted odds ratio of 0.33 (95% CI: 0.14-0.78) was observed.
- HCC surveillance showed a significant association with decreased HCC-related mortality.
Conclusions:
- HCC surveillance is associated with reduced HCC-related mortality, supporting current guideline recommendations.
- Early identification of cirrhosis is critical for improving patient survival.
- Continued adherence to HCC surveillance protocols is advised.
Background And Aims:
Surveillance for hepatocellular carcinoma (HCC) with ultrasound screening is recommended by guidelines. However, there are conflicting data whether HCC-surveillance reduces HCC-related mortality in patients with cirrhosis. The aim of this study was to validate previous findings that found no association between HCC-surveillance and decreased HCC-related mortality.
Methods:
This was a case-control study in patients with cirrhosis from Stockholm County, Sweden. Cases died from HCC between 2004 and 2020. Controls did not die from HCC, and were matched to cases based on age, sex, etiology of cirrhosis, year of cirrhosis diagnosis, hospital site, MELD, and Child-Pugh scores. An adjusted logistic regression model was used to compare exposure to screening ultrasounds 2 years prior to HCC diagnosis between cases and controls. An odds ratio below one would suggest an association between HCC surveillance and decreased HCC-related mortality.
Results:
A total of 1272 patients with cirrhosis and HCC died during follow-up, and 516 of these were excluded as potential cases due to a diagnosis of HCC near the cirrhosis diagnosis. From the potential cases 72 cases and 72 controls were matched. The adjusted odds ratio was 0.33 (95% Confidence Interval [CI] = 0.14-0.78).
Conclusions:
HCC surveillance was associated with decreased HCC-related mortality, indicating that HCC surveillance should continue as recommended in guidelines. However, many patients who died from HCC were diagnosed with HCC close to the cirrhosis diagnosis, suggesting that identifying patients with cirrhosis earlier is highly important for improving HCC-related mortality.
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