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Abstract Details
Surveillance for hepatocellular carcinoma with a 3-months interval in "extremely high-risk" patients does not further improve survival
1Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
2Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy; Veneto Institute of Oncology, Gastroenterology Unit, Via dei Carpani 16/Z, 31033, Castelfranco Veneto, Italy.
3Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, Multivisceral Transplant Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
4Department of Surgery, Oncology and Gastroenterology, Hepatobiliary Surgery and Liver Transplantation Unit, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
5Department of Internal Medicine, Gastroenterology Unit, University of Genova, IRCCS Policlinico San Martino, Viale Benedetto XV 6, 16132, Genova, Italy.
6Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 13, 40138, Bologna, Italy.
7Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Via della Pineta Sacchetti 217, 00168, Roma, Italy.
8Medicine Unit, Bolognini Hospital, Via Paderno 21, 24068, Seriate, Italy.
9Gastroenterology Unit, Belcolle Hospital, Str. Sammartinese, 01100, Viterbo, Italy.
10Internal Medicine-Zoli Unit, Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 13, 40138, Bologna, Italy.
11Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Viale Luigi Pinto 1, 71122, Foggia, Italy.
12Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy.
13Department of Experimental and Clinical Medicine, Internal Medicine and Hepatology Unit, University of Firenze, Largo Brambilla 3, 50134, Firenze, Italy.
14Gastroenterology Unit, Bolzano Regional Hospital, Via Lorenz Böhler 5, 39100, Bolzano, Italy.
15Department of Clinical Medicine and Surgery, Gastroenterology Unit, University of Napoli "Federico II", Via Pansini 5, 80131, Napoli, Italy.
16Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Via della Pineta Sacchetti 217, 00168, Roma, Italy.
17Gastroenterology Unit, Polytechnic University of Marche, Piazza Roma 22, 60121, Ancona, Italy.
Background: An enhanced surveillance schedule has been proposed for cirrhotics with viral etiology, who are considered at extremely high-risk of hepatocellular carcinoma (HCC).
Aims: We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival.
Methods: Data of 777 HBV and HCV cirrhotic patients with HCC diagnosed under a 3-months (n = 109, 3MS group) or a 6-months (n = 668, 6MS group) surveillance were retrieved from the Italian Liver Cancer database. Survival in the 3MS group was considered as observed and adjusted for lead-time bias, and survival analysis was repeated after a propensity score matching.
Results: The 3-months surveillance interval neither reduced the share of patients diagnosed outside the Milano criteria, nor increased their probability to receive curative treatments. The median survival of 6MS patients (55.0 months [45.9-64.0]) was not significantly different from the observed (47.0 months [35.0-58.9]; p = 0.43) and adjusted (44.9 months [33.4-56.4]; p = 0.30) survival of 3MS patients. A propensity score analysis confirmed the absence of a survival advantage for 3MS patients.
Conclusions: A tightening of surveillance schedule does not increase the diagnosis of early-stage tumors, the feasibility of curative treatments and the survival. Therefore, we should maintain the 6-months interval in the surveillance of viral cirrhotics.