Singal AG. Am J Gastroenterol. 2013;doi:10.1038/ajg.2012.449.
February 12, 2013
Poor screening for hepatocellular carcinoma occurs frequently among patients with chronic HCV and advanced fibrosis and can lead to tumor diagnosis at a late stage, according to recent results.
Researchers evaluated hepatocellular carcinoma (HCC) surveillance data from 1,005 patients with chronic hepatitis C with cirrhosis or advanced fibrosis. All participants had been enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial. Incidence of consistent surveillance (CS) — defined as ultrasound and alpha-fetoprotein (AFP) assessment performed at least once every 12 months — was recorded, along with surveillance failures (an absence of screening, follow-up or detection).
During a mean follow-up of 6.1 years, CS occurred in 692 cases, and 278 participants had complete clinic visit adherence. Patients did not undergo HCC screening in 7.5% of cases, nearly all of which (94.1%) was attributed to a lack of ultrasound.
Study site was the factor most strongly predictive of CS in multivariate analysis adjusted for patient characteristics (P<.001). Complete clinic visit adherence (HR=1.72; 95% CI, 1.11-2.63), a platelet count greater than 150,000/mm3 (HR=1.28; 95% CI, 1.05-1.56) and a baseline AFP level less than 20 ng/mL (HR=1.48; 95% CI, 0.99-2.20) were independently predictive of CS.
HCC was detected in 83 evaluable cases. Twenty-three cases were detected at a late stage, including 16 due to absence of detection, four due to lack of follow-up and three due to lack of screening. Of those with HCC detected within Milan criteria, 23.3% had an absence of follow-up and 13.3% an absence of screening within 1 year of diagnosis.
“Our study highlights the underutilization of HCC surveillance, even among patients followed by expert hepatologists in academic centers,” researcher Amit G. Singal, MD, MS, assistant professor at University of Texas Southwestern Medical Center in Dallas, told Healio.com. “Furthermore, our study suggests that there may also be significant delays in follow-up of abnormal screening tests. Surveillance and follow-up rates are likely even lower in clinical practice, given the presence of other potential barriers such as lack of provider knowledge, financial barriers, and more limited access to testing. … These screening process failures likely contribute to more advanced tumor stage at presentation.”
http://www.healio.com/hepatology/oncology/news/online/%7B35BF2CF9-9E4B-437C-BE94-A706A4BCF9D2%7D/Poor-HCC-surveillance-common-may-contribute-to-late-stage-tumors
Researchers evaluated hepatocellular carcinoma (HCC) surveillance data from 1,005 patients with chronic hepatitis C with cirrhosis or advanced fibrosis. All participants had been enrolled in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial. Incidence of consistent surveillance (CS) — defined as ultrasound and alpha-fetoprotein (AFP) assessment performed at least once every 12 months — was recorded, along with surveillance failures (an absence of screening, follow-up or detection).
During a mean follow-up of 6.1 years, CS occurred in 692 cases, and 278 participants had complete clinic visit adherence. Patients did not undergo HCC screening in 7.5% of cases, nearly all of which (94.1%) was attributed to a lack of ultrasound.
Study site was the factor most strongly predictive of CS in multivariate analysis adjusted for patient characteristics (P<.001). Complete clinic visit adherence (HR=1.72; 95% CI, 1.11-2.63), a platelet count greater than 150,000/mm3 (HR=1.28; 95% CI, 1.05-1.56) and a baseline AFP level less than 20 ng/mL (HR=1.48; 95% CI, 0.99-2.20) were independently predictive of CS.
HCC was detected in 83 evaluable cases. Twenty-three cases were detected at a late stage, including 16 due to absence of detection, four due to lack of follow-up and three due to lack of screening. Of those with HCC detected within Milan criteria, 23.3% had an absence of follow-up and 13.3% an absence of screening within 1 year of diagnosis.
“Our study highlights the underutilization of HCC surveillance, even among patients followed by expert hepatologists in academic centers,” researcher Amit G. Singal, MD, MS, assistant professor at University of Texas Southwestern Medical Center in Dallas, told Healio.com. “Furthermore, our study suggests that there may also be significant delays in follow-up of abnormal screening tests. Surveillance and follow-up rates are likely even lower in clinical practice, given the presence of other potential barriers such as lack of provider knowledge, financial barriers, and more limited access to testing. … These screening process failures likely contribute to more advanced tumor stage at presentation.”
http://www.healio.com/hepatology/oncology/news/online/%7B35BF2CF9-9E4B-437C-BE94-A706A4BCF9D2%7D/Poor-HCC-surveillance-common-may-contribute-to-late-stage-tumors
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