Cirrhosis: HCC screening fails to cut cancer-related mortality

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Takeaway

  • Hepatocellular carcinoma (HCC) screening via abdominal ultrasound scan (USS), serum alpha-fetoprotein (AFP), or both were not associated with a decreased risk for HCC-related mortality among patients with cirrhosis.

Why this matters

  • Patients with cirrhosis have a 1%-8% risk for developing HCC.
  • Most professional liver societies recommend HCC screening every 6 months in patients with cirrhosis, despite few data showing benefit.

Study design

  • Case-control study of patients in the US Veterans Affairs (VA) health-care system.
  • Patients with HCC and cirrhosis for ≥4 years prior to cancer diagnosis who either died of HCC (n=238; cases) or survived (n=238; control patients).
  • Funding: National Institutes of Health.

Key results

  • Both groups underwent similar number of screenings over the 4-year period prior to diagnosis.
  • No difference between groups in numbers screened by USS (OR, 0.95; 95% CI, 0.66-1.37), AFP (OR, 1.07; 95% CI, 0.70-1.65), or both (OR, 1.12; 95% CI, 0.70-1.81) within 4 years prior to the index date.
  • After multivariable analysis, no association between screenings 0-4 years prior to cancer diagnosis and HCC mortality (USS: OR, 0.95 [95% CI, 0.63-1.43]; AFP: OR, 1.08 [95% CI, 0.67-1.75]; USS or AFP: OR, 1.11 [95% CI, 0.68-1.82]).

Limitations

  • All male study population.