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Inadequate Hepatocellular Carcinoma Screening in Patients With Nonalcoholic Steatohepatitis Cirrhosis

Aby, Elizabeth, MD*; Phan, Jennifer, MD*; Truong, Emily, BA*; Grotts, Jonathan, MA, BS*; Saab, Sammy, MD, MPH, AGAF, FAASLD, FACG*,†

Journal of Clinical Gastroenterology: February 2019 - Volume 53 - Issue 2 - p 142–146
doi: 10.1097/MCG.0000000000001075

Background: Nonalcoholic steatohepatitis (NASH) is a common cause of liver disease which can progress to cirrhosis and hepatocellular carcinoma (HCC). American Association for the Study of Liver Diseases (AASLD) guidelines recommend abdominal ultrasound, with or without serum alpha-fetoprotein, every 6 months for HCC surveillance in cirrhotic patients.

Goals: Describe HCC surveillance rates in NASH cirrhosis compared with hepatitis C (HCV) cirrhosis and the impact of surveillance on tumor size, treatment, and mortality.

Study: Adults with NASH and HCV cirrhosis diagnosed with HCC from 2009 to 2016 were retrospectively evaluated. Patients were categorized into 3 mutually exclusive disease screening groups based on abdominal imaging with or without serum alpha-fetoprotein testing before HCC diagnosis.

Results: In total, 99 patients with NASH cirrhosis and 162 patients with HCV cirrhosis were evaluated. In total, 51.5% of NASH cirrhosis patients and 25.9% of HCV cirrhosis patients had no screening before HCC diagnosis. Patients with HCV cirrhosis were significantly more likely to undergo surveillance compared with patients with NASH cirrhosis (P=0.002). NASH cirrhosis patients who underwent complete screening had smaller tumors compared with those with incomplete screening and no screening (P=0.006). There were no differences in number of tumors at diagnosis or mortality between screening groups in patients with NASH cirrhosis (P=0.281 and 0.468, respectively).

Conclusions: There is suboptimal HCC surveillance in NASH and HCV cirrhotic patients, with a greater proportion of patients with NASH cirrhosis not undergoing surveillance. Patients with NASH cirrhosis who had complete surveillance had smaller tumors at diagnosis, but there were no differences in treatment outcomes or mortality.

Departments of *Medicine

Surgery at the University of California at Los Angeles, Los Angeles, CA and the Liver Center

S.S., E.A., J.P.: study concept and design. E.A., J.P., E.T.: acquisition of data. J.G., E.A., J.P.: analysis and interpretation of data. E.A., J.P., S.S.: drafting of the manuscript. S.S.: critical revision of the manuscript for important intellectual content; administrative, technical, or material support; study supervision. J.G.: statistical analysis.

The authors declare that they have nothing to disclose.

Address correspondence to: Sammy Saab, MD, MPH, AGAF, FAASLD, FACG, UCLA Medical Center, Pfleger Liver Institute, 200 Medical Plaza, Suite 214, Los Angeles, CA 90095 (e-mail:

Received January 11, 2018

Accepted May 7, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.