Journal of Hepatocellular Carcinoma (Sep 2023)
Improved Survival in At-Risk Patients Undergoing Surveillance for Hepatocellular Carcinoma – A Nationwide Swedish Register-Based Study
Abstract
Richard Thörn,1 Oskar Hemmingsson,2,3 Åsa Danielsson Borssén,1 Mårten Werner,1 Pontus Karling,1 Jonas Wixner1 1Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; 2Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden; 3Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, SwedenCorrespondence: Richard Thörn, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, S-901 87, Sweden, Tel +46706024820, Email [email protected]: Surveillance for hepatocellular carcinoma (HCC) is recommended in at-risk patients, but its effectiveness in Western populations has been questioned. The purpose was to evaluate the effect of surveillance in patients with HCC in a Northern European setting.Patients and Methods: Data on patients diagnosed with HCC between 2009 and 2019 were collected from the nationwide Swedish National Registry for Tumors of the Liver and Bile Ducts (SweLiv). Patients who had undergone HCC surveillance were compared to those who had not (but had an obvious indication for surveillance, ie, liver cirrhosis or hepatic porphyria and an age of ≥ 50 years) regarding etiology, tumor burden, presence of extrahepatic spread, treatment and lead-time adjusted overall survival.Results: A total of 4979 patients with index HCC were identified and information regarding surveillance was available in 4116 patients. Among these, 1078 had got their HCC diagnosis during surveillance, whereas 1647 had been diagnosed without surveillance despite a presumed indication. The most common underlying etiologies for HCC were hepatitis C (28.2%) and alcoholic liver disease (26.9%), and 94.8% had cirrhosis. The surveillance cohort more frequently met the University of California San Francisco-criteria (79% vs 53%, p < 0.001), more often received a potentially curative treatment (62% vs 28%, p < 0.001) and had less extrahepatic spread (7.6% vs 22.4% p < 0.001). After adjustment for lead-time bias (sojourn time of 270 days), the surveillance group had a significantly longer estimated median survival time than the non-surveillance group (34 months vs 11 months, p < 0.001). A multivariable cox regression analysis showed an adjusted hazard ratio of 0.59 (95% CI 0.51– 0.67) in favor of surveillance.Conclusion: Surveillance for HCC in at-risk patients is associated with diagnosis at an earlier tumor stage, treatment with curative intent and with improved lead-time adjusted overall survival. These findings encourage HCC surveillance of at-risk patients also in a Western population.Plain Language Summary: In this research article, we aimed to evaluate whether patients who have a known risk to develop liver cancer have a better prognosis if they undergo regular screening examinations with ultrasound every sixth months. Using information from a nationwide Swedish registry, we investigated the outcome in a large group of patients who had been diagnosed with liver cancer. We compared patients who had performed regular examinations to those who had not and concluded that the screening group had less advanced disease at diagnosis, as well as a better survival.Keywords: hepatocellular carcinoma, surveillance, survival, cirrhosis, chronic liver disease
