HCC-surveillance is associated with improved HCC-related mortality in patients with cirrhosis - a case-control study.

Abstract

Background and aims: Surveillance for hepatocellular carcinoma (HCC) with ultrasound screening is recommended by guidelines. However, there are conflicting data whether HCC-surveillance reduces HCC-related mortality in patients with cirrhosis. The aim of this study was to validate previous findings that found no association between HCC-surveillance and decreased HCC-related mortality.

Methods: This was a case-control study in patients with cirrhosis from Stockholm County, Sweden. Cases died from HCC between 2004 and 2020. Controls did not die from HCC, and were matched to cases based on age, sex, etiology of cirrhosis, year of cirrhosis diagnosis, hospital site, MELD, and Child-Pugh scores. An adjusted logistic regression model was used to compare exposure to screening ultrasounds 2 years prior to HCC diagnosis between cases and controls. An odds ratio below one would suggest an association between HCC surveillance and decreased HCC-related mortality.

Results: A total of 1272 patients with cirrhosis and HCC died during follow-up, and 516 of these were excluded as potential cases due to a diagnosis of HCC near the cirrhosis diagnosis. From the potential cases 72 cases and 72 controls were matched. The adjusted odds ratio was 0.33 (95% Confidence Interval [CI] = 0.14-0.78).

Conclusions: HCC surveillance was associated with decreased HCC-related mortality, indicating that HCC surveillance should continue as recommended in guidelines. However, many patients who died from HCC were diagnosed with HCC close to the cirrhosis diagnosis, suggesting that identifying patients with cirrhosis earlier is highly important for improving HCC-related mortality.