Clinical outcomes of hepatocellular carcinoma surveillance in Melbourne, Australia

Abstract

AbstractBackgroundUltrasound surveillance for hepatocellular carcinoma (HCC) may improve early tumour detection but may additionally result in surveillance‐related harm through increased evaluation of non‐HCC lesions. The incidence of these outcomes has not been reported outside North America.AimsWe aimed to report the outcomes of HCC surveillance with respect to both surveillance‐related benefits and harms.MethodsWe reviewed all HCC surveillance ultrasounds at a large Victorian tertiary hospital network in 2017 and followed their outcomes until 2021. Surveillance‐related benefits were defined as early‐stage HCC detection. Surveillance‐related harm was defined as contrast imaging, biopsies or surgery performed to evaluate non‐HCC liver lesions or false‐positive alpha‐fetoprotein levels.ResultsFive hundred and fifty‐three patients were included (mean age 54.5 ± 12.3 years, males 67.5%, cirrhosis 50.3%). The most common liver disease aetiology was hepatitis B (53.9%). Over a median of 4.7 years follow‐up, early‐stage HCC was detected in 3.3% (5.4% in cirrhotic vs 1.1% in non‐cirrhotic patients, P < 0.01). 75% of all HCCs were early‐stage. Surveillance‐related harm occurred in 12.5% (15.5% in cirrhotic vs 9.5% in non‐cirrhotic patients, P < 0.04), although most harm was mild (12.1%). In subgroup analysis, the detection of early‐stage HCC ranged between 0% (screened outside of guideline criteria and alcoholic cirrhotic patients) and 7.2% (hepatitis C cirrhosis). Harm occurred between 9% (non‐cirrhotic hepatitis B) and 20.8% (thrombocytopenia).ConclusionIn our study, HCC surveillance was associated with early tumour detection, although many patients experienced mild surveillance‐related harm. Novel surveillance strategies and pathways are required to improve detection in high‐risk patients and minimise harm in low‐risk patients.