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The Effect of Hepatocellular Carcinoma Surveillance in an Urban Population With Liver Cirrhosis

Nusbaum, Jeffrey D. MD*; Smirniotopoulos, John MD*; Wright, Henry C. MD*; Dash, Chiranjeev MD, PhD; Parpia, Tarina MS*; Shechtel, Joanna BA*; Chang, Yaojen PhD; Loffredo, Christopher PhD; Shetty, Kirti MD

doi: 10.1097/MCG.0000000000000306
ONLINE ARTICLES: Original Articles

Background: Hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis is aimed at early detection so that effective therapeutic options may be offered. We undertook this study to assess the patterns of surveillance that had been offered to HCC patients evaluated at our center, and the effect of these strategies on outcome.

Methods: Consecutive patients, age 18 years and older, diagnosed with HCC between December 2007 and December 2012 were identified. Surveillance was defined as α-fetoprotein measurement and/or imaging examination in the 12 months before HCC diagnosis. Logistic regression and survival analysis models were utilized to investigate the association of surveillance with patient characteristics and survival.

Results: A total of 305 patients with HCC and a background of cirrhosis were analyzed. HCC was detected by surveillance in 131 patients (43%). Of those who underwent surveillance, 92% were diagnosed with early-stage cancer (stages I and II) compared with 62% of those who did not undergo surveillance (P<0.001). The rate of surgical therapy (hepatic resection and liver transplantation) was almost doubled in the surveillance group (61% vs. 33%, P<0.05). At median follow-up of 27.3 months, overall survival was high at 55% and surveillance was significantly associated with longer survival (P=0.006).

Conclusions: At our center, surveillance efficacy for HCC detection was notably higher than earlier reported.

Impact: Patients who underwent surveillance were more likely to have their tumors detected at an early stage, to qualify for surgical therapy, and to have improved survival.

*Transplant Institute, Georgetown University Hospital

Lombardi Comprehensive Cancer Center, Georgetown University Medical Center

Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Washington, DC

The authors declare that they have nothing to disclose.

Reprints: Kirti Shetty, MD, Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institutions, Sibley Medical Building, #320, 5215 Loughboro Road, Washington, DC 20016 (e-mail:

Received September 17, 2014

Accepted January 30, 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.