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Ningarhari M, Mourad A, Delacôte C, Ntandja Wandji LC, Lassailly G, Louvet A, Dharancy S, Mathurin P, Deuffic-Burban S. Benefits of tailored hepatocellular carcinoma screening in patients with cirrhosis on cancer-specific and overall mortality: A modeling approach. Hepatol Commun 2022; 6:2964-2974. [PMID: 36004703 PMCID: PMC9512473 DOI: 10.1002/hep4.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022] Open
Abstract
To validate cancer screening programs, experts recommend estimating effects on case fatality rates (CFRs) and cancer‐specific mortality. This study evaluates hepatocellular carcinoma (HCC) screening in patients with cirrhosis for those outcomes using a modeling approach. We designed a Markov model to assess 10‐year HCC‐CFR, HCC‐related, and overall mortality per 100,000 screened patients with compensated cirrhosis. The model evaluates different HCC surveillance intervals (none, annual [12 months], semiannual [6 months], or quarterly [3 months]) and imaging modalities (ultrasound [US] or magnetic resonance imaging [MRI]) in various annual incidences (0.2%, 0.4%, or 1.5%). Compared to no surveillance, 6‐month US reduced the 10‐year HCC‐CFR from 77% to 46%. With annual incidences of 0.2%, 0.4%, and 1.5%, the model predicted 281, 565, and 2059 fewer HCC‐related deaths, respectively, and 187, 374, and 1356 fewer total deaths per 100,000 screened patients, respectively. Combining alpha‐fetoprotein screening to 6‐month US led to 32, 63, and 230 fewer HCC‐related deaths per 100,000 screened patients for annual incidences of 0.2%, 0.4%, and 1.5%, respectively. Compared to 6‐month US, 3‐month US reduced cancer‐related mortality by 14%, predicting 61, 123, and 446 fewer HCC‐related deaths per 100,000 screened patients with annual incidences of 0.2%, 0.4%, and 1.5%, respectively. Compared to 6‐month US, 6‐month MRI (−17%) and 12‐month MRI (−6%) reduced HCC‐related mortality. Compared to 6‐month US, overall mortality reductions ranged from −0.1% to −1.3% when using 3‐month US or MRI. A US surveillance interval of 6 months improves HCC‐related and overall mortality compared to no surveillance. A shorter US interval or using MRI could reduce HCC‐CFR and HCC‐related mortality, with a modest effect on overall mortality.
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Affiliation(s)
- Massih Ningarhari
- Centre Hospitalier Universitaire de Lille, Hôpital Huriez, Maladies de l'Appareil Digestif, Lille, France.,Université de Lille, Institut national de la santé et de la recherche médicale (INSERM), Infinite, Lille, France
| | - Abbas Mourad
- Université de Lille, Institut national de la santé et de la recherche médicale (INSERM), Infinite, Lille, France
| | - Claire Delacôte
- Université de Lille, Institut national de la santé et de la recherche médicale (INSERM), Infinite, Lille, France
| | - Line-Carolle Ntandja Wandji
- Centre Hospitalier Universitaire de Lille, Hôpital Huriez, Maladies de l'Appareil Digestif, Lille, France.,Université de Lille, Institut national de la santé et de la recherche médicale (INSERM), Infinite, Lille, France
| | - Guillaume Lassailly
- Centre Hospitalier Universitaire de Lille, Hôpital Huriez, Maladies de l'Appareil Digestif, Lille, France.,Université de Lille, Institut national de la santé et de la recherche médicale (INSERM), Infinite, Lille, France
| | - Alexandre Louvet
- Centre Hospitalier Universitaire de Lille, Hôpital Huriez, Maladies de l'Appareil Digestif, Lille, France.,Université de Lille, Institut national de la santé et de la recherche médicale (INSERM), Infinite, Lille, France
| | - Sébastien Dharancy
- Centre Hospitalier Universitaire de Lille, Hôpital Huriez, Maladies de l'Appareil Digestif, Lille, France.,Université de Lille, Institut national de la santé et de la recherche médicale (INSERM), Infinite, Lille, France
| | - Philippe Mathurin
- Centre Hospitalier Universitaire de Lille, Hôpital Huriez, Maladies de l'Appareil Digestif, Lille, France.,Université de Lille, Institut national de la santé et de la recherche médicale (INSERM), Infinite, Lille, France
| | - Sylvie Deuffic-Burban
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, Infection, Antimicrobials, Modelling, Evolution, Paris, France
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Parikh ND, Tayob N, Al-Jarrah T, Kramer J, Melcher J, Smith D, Marquardt P, Liu PH, Tang R, Kanwal F, Singal AG. Barriers to Surveillance for Hepatocellular Carcinoma in a Multicenter Cohort. JAMA Netw Open 2022; 5:e2223504. [PMID: 35867057 PMCID: PMC9308050 DOI: 10.1001/jamanetworkopen.2022.23504] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/02/2022] [Indexed: 01/07/2023] Open
Abstract
Importance Hepatocellular carcinoma (HCC) surveillance is underused in clinical practice, which may be owing to patient and clinician barriers. Objective To characterize HCC surveillance barriers and associations with clinical outcomes in a multicenter cohort of patients with cirrhosis. Design, Setting, and Participants This retrospective, multicenter cohort study included 5 medical centers in the United States. Patients with cirrhosis and newly diagnosed HCC treated from 2014 to 2018 were included. Data were analyzed from June 2021 to February 2022. Exposure Surveillance completion in the 36-month period prior to HCC diagnosis. Main Outcomes and Measures Surveillance receipt was classified as semiannual, annual, or no surveillance. Multivariable logistic regression analysis was used to identify factors associated with semiannual surveillance. We conducted multivariable logistic and Cox regression analyses to characterize associations between surveillance completion with curative treatment and overall survival. Results A total 629 eligible patients (median [IQR] age, 63.6 [56.2-71.0] years; 491 [78.1%] men) were assessed, including 7 American Indian or Alaska Native patients (1.1%), 14 Asian patients (2.2), 176 Black patients (28.0%), 86 Hispanic patients (13.1%), and 340 White patients (54.1%). Nearly two-thirds of the cohort had no surveillance prior to HCC diagnosis (mean [range by site] 63.7% [37.9%-80.4%]), with a mean (range by site) of 14.0% (5.3%-33.3%) of patients having received semiannual surveillance and 22.3% (14.3%-28.8%) of patients having received annual surveillance. The most common reasons for no surveillance were lack of surveillance orders or nonadherence (mean [range by site], 82.4% [66.7%-92.4%], although a mean (range by site) of 17.6% (10.2%-22.1%) of patients had unrecognized cirrhosis at HCC presentation. Semiannual surveillance was associated with hepatitis B infection (odds ratio [OR], 3.06 [95% CI, 1.24-7.23]) and inversely associated with Black race (OR, 0.41 [95% CI, 0.20-0.80]) and lack of cirrhosis recognition (OR, 0.14 [95% CI, 0.02-0.46]). Semiannual HCC surveillance was significantly associated with curative treatment receipt (OR, 2.73 [95% CI, 1.60-4.70]) but not overall survival (HR, 0.81 [95% CI, 0.55-1.18]). Conclusions and Relevance In this cohort study of patients with cirrhosis, HCC surveillance was underused in more than 80% of patients and associated with failures across the screening process. Dedicated programs to improve cirrhosis detection and HCC surveillance attainment are needed.
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Affiliation(s)
- Neehar D. Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor
| | - Nabihah Tayob
- Department of Biostatistics, Dana Farber Cancer Center, Boston, Massachusetts
| | - Taim Al-Jarrah
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor
| | - Jennifer Kramer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Jennifer Melcher
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Donna Smith
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Patrick Marquardt
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Po-Hong Liu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Runlong Tang
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Fasiha Kanwal
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
- Division of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Amit G. Singal
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
- Harold C. Simmons Cancer Center, University of Texas Southwestern Medical Center, Dallas
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