Surveillance for hepatocellular carcinoma promotes cancer diagnosis at early stages and improves survival employing both, ?local? or ?non-local? ultrasound

RIDRUEJO E; MENDIZABAL M; SILVA M; PIÑERO F

Londres

Congreso; Annual Meeting ILCA - International Liver Cancer Association; 2018

Background & Aims: Although a randomized trial from Asia and other observational cohort studies have shown improvement on survival regarding surveillance for hepatocellular carcinoma (HCC), evidenced-based data in the daily practice is still lacking. Different international guidelines recommend that expert sonographers should perform ultrasound (US) biannual screening. However, US sensitivity has several threats as it is "operator dependent?. Therefore, our aim was to compare the effectiveness of local vs non-local US screening upon survival and HCC staging at diagnosis in the daily practice in a multicenter cohort from Argentina.Methods: This study was conducted between 2009 and 2016 in 14 hospitals including a dual cohort of adult patients with newly diagnosed HCC (cohort 1 was a retrospective whereas cohort 2 was a prospective cohort study). Surveillance for HCC was considered as recommended by international guidelines and done with biannual US. The site where the last US was performed was categorized as local or external if it was done in or outside the local hospital. The main outcome of routine surveillance was HCC diagnosis at BCLC 0-A stages considered as potentially candidates for curative treatments. Thus, surveillance failure was defined as HCC diagnosis not meeting this tumor burden. A multivariate Cox regression analysis with hazard ratios (HR) and 95% CI was performed. Kaplan Meier survival curves were compared using the log-rank test.Results: A total of 533 consecutive patients with HCC were included (cohort 1 n=478, cohort 2 n=75). Overall, 62.4% of the cohort was under routine surveillance; local US was performed in 32.2% (n=178). Patients who were under surveillance were younger, were predominantly HCV+ and had more frequently portal hypertension then those without routine surveillance. At HCC diagnosis, tumor number, largest nodule diameter, serum AFP values and presence of vascular or extrahepatic involvement were lower in patients with than in those without surveillance. Routine surveillance was more likely to present with HCC diagnosed at Barcelona Clinic Liver Cancer (BCLC) stages 0-A (70.7% versus no-screening 32.7%; P