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Improved survival in at-risk patients undergoing surveillance for hepatocellular carcinoma: a nationwide Swedish register-based study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).ORCID iD: 0000-0003-1732-168x
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
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2023 (English)In: Journal of Hepatocellular Carcinoma, E-ISSN 2253-5969, Vol. 10, p. 1573-1586Article in journal (Refereed) Published
Abstract [en]

Purpose: Surveillance for hepatocellular carcinoma (HCC) is recommended in at-risk patients, but its effectiveness in Western populations has been questioned. The purpose was to evaluate the effect of surveillance in patients with HCC in a Northern European setting.

Patients and Methods: Data on patients diagnosed with HCC between 2009 and 2019 were collected from the nationwide Swedish National Registry for Tumors of the Liver and Bile Ducts (SweLiv). Patients who had undergone HCC surveillance were compared to those who had not (but had an obvious indication for surveillance, ie, liver cirrhosis or hepatic porphyria and an age of ≥50 years) regarding etiology, tumor burden, presence of extrahepatic spread, treatment and lead-time adjusted overall survival.

Results: A total of 4979 patients with index HCC were identified and information regarding surveillance was available in 4116 patients. Among these, 1078 had got their HCC diagnosis during surveillance, whereas 1647 had been diagnosed without surveillance despite a presumed indication. The most common underlying etiologies for HCC were hepatitis C (28.2%) and alcoholic liver disease (26.9%), and 94.8% had cirrhosis. The surveillance cohort more frequently met the University of California San Francisco-criteria (79% vs 53%, p <0.001), more often received a potentially curative treatment (62% vs 28%, p <0.001) and had less extrahepatic spread (7.6% vs 22.4% p <0.001). After adjustment for lead-time bias (sojourn time of 270 days), the surveillance group had a significantly longer estimated median survival time than the non-surveillance group (34 months vs 11 months, p <0.001). A multivariable cox regression analysis showed an adjusted hazard ratio of 0.59 (95% CI 0.51–0.67) in favor of surveillance.

Conclusion: Surveillance for HCC in at-risk patients is associated with diagnosis at an earlier tumor stage, treatment with curative intent and with improved lead-time adjusted overall survival. These findings encourage HCC surveillance of at-risk patients also in a Western population.

Place, publisher, year, edition, pages
Dove Medical Press, 2023. Vol. 10, p. 1573-1586
Keywords [en]
chronic liver disease, cirrhosis, hepatocellular carcinoma, surveillance, survival
National Category
Surgery Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:umu:diva-214985DOI: 10.2147/JHC.S420130ISI: 001074270400001PubMedID: 37753268Scopus ID: 2-s2.0-85171845818OAI: oai:DiVA.org:umu-214985DiVA, id: diva2:1804674
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Region VästerbottenAvailable from: 2023-10-13 Created: 2023-10-13 Last updated: 2024-01-25Bibliographically approved

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Thörn, RichardHemmingsson, OskarDanielsson Borssén, ÅsaWerner, MårtenKarling, PontusWixner, Jonas

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Thörn, RichardHemmingsson, OskarDanielsson Borssén, ÅsaWerner, MårtenKarling, PontusWixner, Jonas
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Department of Public Health and Clinical MedicineDepartment of Surgical and Perioperative SciencesWallenberg Centre for Molecular Medicine at Umeå University (WCMM)
SurgeryGastroenterology and Hepatology

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CiteExportLink to record
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