Meta-Analysis: Utilisation of Hepatocellular Carcinoma Surveillance.

Abstract

BACKGROUND AND AIMS Major society guidelines recommend hepatocellular carcinoma (HCC) surveillance every 6 months with hepatic ultrasound. HCC surveillance is associated with early detection and improved survival but is underutilised. We aim to provide an updated assessment of HCC surveillance utilisation. METHODS Ovid MEDLINE and Embase were searched from inception until 30 November 2023 to identify studies reporting the proportion of people with either cirrhosis or chronic hepatitis B who underwent ultrasound-based HCC surveillance. The primary objective was to determine the utilisation of HCC surveillance. A meta-analysis of proportions was conducted using a generalised linear mixed model. RESULTS Forty-eight articles (1,275,349 individuals) met inclusion criteria. In at-risk individuals (cirrhosis or chronic hepatitis B), pooled utilisation of any HCC surveillance (n = 21 studies) was 54.45% (95% CI: 37.77-70.19), and utilisation of biannual surveillance (n = 7 studies) was 8.76% (95% CI: 2.46-26.79). Utilisation of any HCC surveillance was 53.37% (95% CI: 33.72-72.03) in patients with cirrhosis (n = 15 studies) and 66.43% (95% CI: 42.74-83.99) in patients with chronic hepatitis B (n = 12 studies), while utilisation of biannual surveillance was 10.20% (95% CI: 1.92-39.71) and 12.96% (95% CI: 0.02-99.09) respectively. Utilisation of surveillance did not improve over time. Pooled analysis of 40,497 individuals diagnosed with HCC (n = 27 studies) determined that the proportion of patients who had undergone prior screening or been diagnosed by surveillance was 36.07% (95% CI: 28.30-44.63). CONCLUSIONS Less than 10% of patients received the recommended biannual ultrasound scans for surveillance. These findings are concerning and call for greater awareness and collaboration between care providers and healthcare policymakers to improve surveillance utilisation.