In the Journals

Routine ultrasonography improves survival in viral hepatitis with HCC

Routine ultrasonographic surveillance led to improved survival and reduced mortality risk in patients with viral hepatitis and hepatocellular carcinoma, according to published findings.

Researchers conducted a population-based retrospective cohort study of adult patients with viral hepatitis, with and without cirrhosis, diagnosed with HCC in Ontario, Canada, between January 2000 and December 2010. All data was extracted from the Ontario Cancer Registry, a population-based cancer registry that collects data on incident cases of all tumors in Ontario (except non-melanoma skin cancers). The data was evaluated to examine ultrasonographic surveillance and its impact on survival and mortality risk, as well as determine predictors of receiving ultrasonographic surveillance before an HCC diagnosis in patients with viral hepatitis-induced HCC.

“Currently, practice guidelines from the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver and the multidisciplinary Canadian consensus recommendations for the management and treatment of HCC suggest surveillance for patients at high risk for HCC to detect cancer at an early stage when it is amenable to potentially curative therapy,” the researchers wrote. “Despite the obvious benefits of early intervention in HCC and the lack of alternative treatments in advanced disease, surveillance measures are not routinely implemented.”

A total of 1,483 patients were included in the final analysis and had been diagnosed with viral hepatitis at least 2 years before the HCC diagnosis.

The unadjusted median survival of the patients after HCC diagnosis was 27 months among patients who received routine surveillance, 21.4 months for patients with inconsistent screening and 15.7 months for patients who did not undergo screening.

The 3-year and 5-year survival rates were 44.5% and 33.4% for patients with routine surveillance, 37.5% and 23.3% for patients with inconsistent screening and 29.9% and 20.7% for patients with no screening.

The 3-year survival rates were 42.6%/41.1% and 35.7%/34.8% after HCC diagnosis of routine surveillance and inconsistent screening when corrected for lead-time bias. The corrected 5-year survival rates were 31.9%/31.8% and 22.4%/20.5%, respectively.

“There were significant differences in median survival between routine surveillance and no screening and in cumulative survival between routine surveillance and no screening, as well as between routine surveillance and inconsistent screening,” the researchers wrote.

In the fully adjusted model, routine surveillance was associated with a lower mortality risk and a hazard ratio of 0.76 (95% CI, 0.64-0.91) and 0.81 (95%, CI: 0.68-0.97), compared with unscreened patients, after being corrected for the respective lead-time bias.

The researchers concluded: “Our findings suggest that routine ultrasonography in patients with viral hepatitis is associated with improved survival and reduced mortality risk in a population-based setting. The data emphasizes the importance of surveillance for timely intervention in HCC-diagnosed patients.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.

Routine ultrasonographic surveillance led to improved survival and reduced mortality risk in patients with viral hepatitis and hepatocellular carcinoma, according to published findings.

Researchers conducted a population-based retrospective cohort study of adult patients with viral hepatitis, with and without cirrhosis, diagnosed with HCC in Ontario, Canada, between January 2000 and December 2010. All data was extracted from the Ontario Cancer Registry, a population-based cancer registry that collects data on incident cases of all tumors in Ontario (except non-melanoma skin cancers). The data was evaluated to examine ultrasonographic surveillance and its impact on survival and mortality risk, as well as determine predictors of receiving ultrasonographic surveillance before an HCC diagnosis in patients with viral hepatitis-induced HCC.

“Currently, practice guidelines from the American Association for the Study of Liver Diseases, the European Association for the Study of the Liver and the multidisciplinary Canadian consensus recommendations for the management and treatment of HCC suggest surveillance for patients at high risk for HCC to detect cancer at an early stage when it is amenable to potentially curative therapy,” the researchers wrote. “Despite the obvious benefits of early intervention in HCC and the lack of alternative treatments in advanced disease, surveillance measures are not routinely implemented.”

A total of 1,483 patients were included in the final analysis and had been diagnosed with viral hepatitis at least 2 years before the HCC diagnosis.

The unadjusted median survival of the patients after HCC diagnosis was 27 months among patients who received routine surveillance, 21.4 months for patients with inconsistent screening and 15.7 months for patients who did not undergo screening.

The 3-year and 5-year survival rates were 44.5% and 33.4% for patients with routine surveillance, 37.5% and 23.3% for patients with inconsistent screening and 29.9% and 20.7% for patients with no screening.

The 3-year survival rates were 42.6%/41.1% and 35.7%/34.8% after HCC diagnosis of routine surveillance and inconsistent screening when corrected for lead-time bias. The corrected 5-year survival rates were 31.9%/31.8% and 22.4%/20.5%, respectively.

“There were significant differences in median survival between routine surveillance and no screening and in cumulative survival between routine surveillance and no screening, as well as between routine surveillance and inconsistent screening,” the researchers wrote.

In the fully adjusted model, routine surveillance was associated with a lower mortality risk and a hazard ratio of 0.76 (95% CI, 0.64-0.91) and 0.81 (95%, CI: 0.68-0.97), compared with unscreened patients, after being corrected for the respective lead-time bias.

The researchers concluded: “Our findings suggest that routine ultrasonography in patients with viral hepatitis is associated with improved survival and reduced mortality risk in a population-based setting. The data emphasizes the importance of surveillance for timely intervention in HCC-diagnosed patients.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.