Effectiveness of AFP and ultrasound tests on hepatocellular carcinoma mortality in HCV-infected patients in the USA

[Guest guest]

http://gut.bmj.com/content/early/2011/01/21/gut.2010.230508.short?rss=1

Gut doi:10.1136/gut.2010.230508

Hepatology

Effectiveness of AFP and ultrasound tests on hepatocellular carcinoma mortality

in HCV-infected patients in the USA

Hashem B El-Serag1,2, R Kramer1, G Chen1, Zhigang Duan1, A

1, A Davila1

+ Author Affiliations

1Houston Center for Quality of Care & Utilization Studies, Sections of Health

Services Research, Baylor College of Medicine, Houston, Texas, USA

2Gastroenterology and Hepatology section at the E. DeBakey Veterans

Affairs Medical Center, Baylor College of Medicine, Houston, Texas, USA

Correspondence to

Hashem B El-Serag, The E DeBakey VA Medical Center, 2002 Holcombe Blvd.

(152), Houston, TX 77030, USA; hasheme@...

Contributors HBE-S has had full access to all of the data in this study and

takes responsibility for the integrity of the data and accuracy of the data

analysis. Conception and design: HBE-S, JAD, JRK, PAR and ZD. Acquisition of the

data: JAD. Analysis: ZD, JAD, PAR, JRK and HBE-S. Interpretation of the data:

HBE-S, JAD, JRK, PAR and ZD. Manuscript preparation and review: HBE-S, JAD, JRK,

PAR and ZD.

Revised 1 December 2010

Accepted 2 December 2010

Published Online First 21 January 2011

Abstract

Background and aims The effectiveness of surveillance for hepatocellular

carcinoma (HCC) in the USA is largely unknown. The objective of this study was

to evaluate the effectiveness of HCC surveillance in a national Veterans

Administration (VA) practice setting, using the national VA hepatitis C virus

(HCV) Clinical Case Registry.

Method The cohort consisted of 1480 HCV-infected patients who developed HCC

during 1998-2007. The timing and intensity of receiving á-fetoprotein (AFP) and

abdominal ultrasound (US) for HCC surveillance were evaluated. Overall mortality

risk was examined using proportional hazards regression models adjusting for

demographics, clinical features and receipt of HCC-specific treatment.

Results The mean survival was 1.8 years following the HCC diagnosis date.

Surveillance AFP or US were recorded in 77.8% of patients within 2 years prior

to HCC diagnosis. Annual surveillance with both AFP and US was observed in only

2% of patients. The presence of either AFP or US surveillance during both 0-6

month and 7-24 month periods before HCC diagnosis was associated with a lower

mortality risk (HR 0.71, 95% CI 0.62 to 0.82) compared with no surveillance.

Receipt of two or more surveillance tests in the 0-6 months (HR 0.76 95% CI 0.66

to 0.88) and to a lesser extent in the 7-12 months (HR 0.81 95% CI 0.1 to 0.99)

prior to HCC diagnosis was also associated with reduced mortality risk.

Conclusions Most patients with HCV-related cirrhosis do not receive regular

imaging-based surveillance. The effectiveness of HCC surveillance tests in

current clinical practice is rather modest in reducing HCC-related mortality.

[Guest guest]

http://gut.bmj.com/content/early/2011/01/21/gut.2010.230508.short?rss=1

Gut doi:10.1136/gut.2010.230508

Hepatology

Effectiveness of AFP and ultrasound tests on hepatocellular carcinoma mortality

in HCV-infected patients in the USA

Hashem B El-Serag1,2, R Kramer1, G Chen1, Zhigang Duan1, A

1, A Davila1

+ Author Affiliations

1Houston Center for Quality of Care & Utilization Studies, Sections of Health

Services Research, Baylor College of Medicine, Houston, Texas, USA

2Gastroenterology and Hepatology section at the E. DeBakey Veterans

Affairs Medical Center, Baylor College of Medicine, Houston, Texas, USA

Correspondence to

Hashem B El-Serag, The E DeBakey VA Medical Center, 2002 Holcombe Blvd.

(152), Houston, TX 77030, USA; hasheme@...

Contributors HBE-S has had full access to all of the data in this study and

takes responsibility for the integrity of the data and accuracy of the data

analysis. Conception and design: HBE-S, JAD, JRK, PAR and ZD. Acquisition of the

data: JAD. Analysis: ZD, JAD, PAR, JRK and HBE-S. Interpretation of the data:

HBE-S, JAD, JRK, PAR and ZD. Manuscript preparation and review: HBE-S, JAD, JRK,

PAR and ZD.

Revised 1 December 2010

Accepted 2 December 2010

Published Online First 21 January 2011

Abstract

Background and aims The effectiveness of surveillance for hepatocellular

carcinoma (HCC) in the USA is largely unknown. The objective of this study was

to evaluate the effectiveness of HCC surveillance in a national Veterans

Administration (VA) practice setting, using the national VA hepatitis C virus

(HCV) Clinical Case Registry.

Method The cohort consisted of 1480 HCV-infected patients who developed HCC

during 1998-2007. The timing and intensity of receiving á-fetoprotein (AFP) and

abdominal ultrasound (US) for HCC surveillance were evaluated. Overall mortality

risk was examined using proportional hazards regression models adjusting for

demographics, clinical features and receipt of HCC-specific treatment.

Results The mean survival was 1.8 years following the HCC diagnosis date.

Surveillance AFP or US were recorded in 77.8% of patients within 2 years prior

to HCC diagnosis. Annual surveillance with both AFP and US was observed in only

2% of patients. The presence of either AFP or US surveillance during both 0-6

month and 7-24 month periods before HCC diagnosis was associated with a lower

mortality risk (HR 0.71, 95% CI 0.62 to 0.82) compared with no surveillance.

Receipt of two or more surveillance tests in the 0-6 months (HR 0.76 95% CI 0.66

to 0.88) and to a lesser extent in the 7-12 months (HR 0.81 95% CI 0.1 to 0.99)

prior to HCC diagnosis was also associated with reduced mortality risk.

Conclusions Most patients with HCV-related cirrhosis do not receive regular

imaging-based surveillance. The effectiveness of HCC surveillance tests in

current clinical practice is rather modest in reducing HCC-related mortality.