Cirrhosis: Data Supports Surveillance for Liver Cancer Screening

Amit Singal MD MS Assistant Professor of Medicine Medical Director, Liver Tumor Program Dedman Scholar of Clinical Care Division of Digestive and Liver Diseases University of Texas Southwestern Dallas TX 75201 - 8887MedicalResearch.com Interview with:
Amit Singal MD MS
Assistant Professor of Medicine
Medical Director, Liver Tumor Program
Dedman Scholar of Clinical Care
Division of Digestive and Liver Diseases
University of Texas Southwestern
Dallas TX 75201 – 8887

MedicalResearch: What are the main findings of the study?

Dr. Singal: We conducted a meta-analysis of current studies to characterize the association between hepatocellular carcinoma surveillance and early detection, curative treatment rates, and overall survival in patients with cirrhosis.  We identified 47 studies with 15,158 patients, of whom 6,284 (41.4%) had hepatocellular carcinoma  detected by surveillance. Hepatocellular carcinoma  surveillance was associated with improved early stage detection (OR 2.08, 95% CI 1.80–2.37) and curative treatment rates (OR 2.24, 95% CI 1.99–2.52). These associations were robust to several sensitivity analyses, including study design, study location, and study period. Hepatocellular carcinoma  surveillance was associated with significantly prolonged survival (OR 1.90, 95% CI 1.67–2.17), which remained significant in the subset of studies adjusting for lead-time bias. Three-year survival rates were 50.8% among patients who underwent surveillance, compared to only 28.2% among hepatocellular carcinoma  patients with tumors detected outside of a surveillance program.


MedicalResearch: Were any of the findings unexpected?

Dr. Singal: The lack of randomized data for hepatocellular carcinoma  surveillance in patients with cirrhosis has spurred questions regarding its benefit; however, the lack of a randomized trial does not equate to a lack of data supporting its efficacy. There are limitations in current literature, including many studies failing to adequately adjust for lead-time bias. However, the preponderance of data that consistently demonstrate benefits should provide sufficient rationale to recommend hepatocellular carcinoma  surveillance, even in the absence of a randomized controlled trial among patients with cirrhosis.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Singal: These data support guidelines that recommend hepatocellular carcinoma  surveillance in patients with cirrhosis. Efforts must be made to increase hepatocellular carcinoma  surveillance rates, given less than 20% of at-risk patients currently undergo hepatocellular carcinoma  surveillance.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Singal: We are currently conducting several studies among patients and providers to determine why surveillance for hepatocellular carcinoma is being underutilized. We are also conducting the first randomized controlled trial to compare the effectiveness of interventions to increase hepatocellular carcinoma surveillance rates in patients with cirrhosis. We are hoping these studies will help improve the effectiveness of hepatocellular carcinoma surveillance efforts in the near future.

Citation:

Early Detection, Curative Treatment, and Survival Rates for Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis: A Meta-analysis

Amit G. Singal, Anjana Pillai, Jasmin Tiro

PLOS Medicine Published: April 01, 2014 DOI: 10.1371/journal.pmed.1001624