No significant impact of HCC surveillance on overall mortality – data from a tertiary referral center in Germany

Background:

International guidelines recommend hepatocellular carcinoma (HCC) surveillance in high-risk patients with chronic liver diseases (CLD), particularly in those with cirrhosis. The goal of surveillance is to detect HCC at an early stage when it is amenable to curative therapy and to reduce liver-related mortality. However, there is low-strength evidence about the effects on mortality. The aim of our study was to assess the impact of surveillance on the clinical course and survival of HCC patients seen at a tertiary referral center in Germany.

Methods:

We retrospectively evaluated the data of 401 HCC patients with CLD of various etiologies, who presented to our clinic between 1997 and 2015. Two groups were built: group 1 (surveillance group) included patients who did not suffer from HCC at initial contact and had at least 2 ultrasound examinations for surveillance purposes (n = 111). Group 2 (non-surveillance group) consisted of patients with HCC at first presentation and without any foregoing HCC surveillance (n = 290). Groups were compared regarding patient and disease characteristics, liver transplantation and survival time.

Results:

The main underlying etiology was chronic hepatitis C infection (39%). The majority (75%) of HCC patients were male. Median follow-up in group 1 was 76 months (range 4 – 310 months). At first diagnosis of HCC, patients of group 1 were younger (63 years (range 40 – 82 years) vs. 66 years (range 19 – 86 years); p < 0.001), suffered more often from cirrhosis (96% vs. 78%; p < 0.001), had smaller median tumor sizes (3.5 cm (range 1 – 14 cm) vs. 4.5 cm (range 1 – 20 cm); p < 0.001), fulfilled more often Milan criteria (73% vs. 46%; p < 0.001) and received more often liver transplantation (33% vs. 10%) when compared to group 2. However, HCC surveillance did not improve overall survival significantly (14 months (range 4 – 214 months) in group 1 vs. 12 months (range 1 – 231 months) in group 2; n.s.). 1-, 3- and 5- year survival rates were 55%, 29% and 19% in group 1 and 52%, 27% and 15% in group 2, respectively.

Conclusions:

In our study, HCC surveillance with ultrasound, led to the detection of HCC in earlier stages. However, this gain in lead time did not result in a significant overall improvement of survival. Further prospective and long-term studies in patients at risk with strict adherence to recommended surveillance intervals are needed to clarify the impact of HCC surveillance programs on mortality.