Impact of surveillance and early-stage versus late-stage hepatocellular carcinoma (HCC) detection on patient overall survival

Date

2018-08

Authors

Bui, Cat Nguyen

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Abstract

This study investigated the impact of surveillance and early-stage versus late-stage hepatocellular carcinoma (HCC) detection on patients’ overall survival using a national US health plan database (1/1/2007 through 12/31/2012).
Eligible Medicare patients were included in this two-phase study. Phase A assessed cirrhotic patients with surveillance versus no-surveillance from the cirrhosis diagnosis index date. Phase B assessed HCC patients with early-stage versus late-stage HCC detection from the HCC diagnosis index date. Phase A included 6,131 cirrhotic patients (surveillance N=3,376, no-surveillance N=2,755); 73% (N=4,443) decompensated and 27% (N=1,688) compensated patients; 145 (2.4%) with HCC; and 814 (13.3%) deaths. Among all cirrhotic patients, the surveillance cohort had a 28% higher risk of death compared to the no-surveillance cohort (adjusted hazard ratio [HR]=1.28; 95% CI=1.10-1.49; P<0.001); a non-statistically significant reduced risk among the subgroup of compensated-only patients (adjusted HR=0.68; 95% CI=0.46-1.02; P=0.06); a non-significant increased risk among cirrhotic patients with HCC (adjusted HR=1.18; 95% CI=0.70-1.98; P=0.54). The surveillance cohort had no significant difference in the odds of early-stage HCC detection compared to the no-surveillance cohort (adjusted odds ratio [OR]=1.77; 95% CI=0.80-3.91; P=0.16). Decompensated cirrhotic patients had higher odds of early-stage HCC detection compared to compensated patients (adjusted OR=5.12; 95% CI=1.12-23.35; P=0.03). Phase B (HCC) patients included 580 early-stage and 1,173 late-stage diagnoses; half (N=886) had cirrhosis pre-HCC index diagnosis (compensated: 13.0%, N=115; decompensated: 87.0%, N=771); 10% (N=181) received one regular surveillance a year pre-HCC index; 36 % (N=636) received HCC treatment (82.1%; N=522/636 received systemic chemotherapy); and 587 (33.5%) patients died. Patients with late-stage HCC diagnoses had a 60% higher risk of death compared to early-stage HCC diagnoses (adjusted HR=1.60; 95% CI=1.23-2.09; P=0.001). Patients with one regular surveillance a year pre-HCC diagnosis had a 29% lower risk of death compared to patients without regular surveillance (adjusted HR=0.71; 95% CI=0.51-0.97; P=0.03). This study found that surveillance had no survival benefit among all cirrhotic patients; however, surveillance reduced the risk of death among compensated cirrhotic patients, although non-significant. HCC patients with at least one regular surveillance a year pre-HCC diagnosis had a lower risk of death. Surveillance should be provided to patients before HCC diagnosis.

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