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Abstract Details
Utilization of Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis: A Systematic Review and Meta-Analysis
Hepatology. 2020 May 8.doi: 10.1002/hep.31309. Online ahead of print.
Erin Wolf1, Nicole E Rich1, Jorge A Marrero1, Neehar Parikh2, Amit G Singal1
Author information
1Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States.
2Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.
Abstract
Hepatocellular carcinoma (HCC) surveillance is associated with early tumor detection and improved survival; however, it is often underused in clinical practice. We aimed to characterize surveillance utilization among patients with cirrhosis and the efficacy of interventions to increase surveillance. We performed a systematic literature review using the MEDLINE database from January 2010 through August 2018 to identify cohort studies evaluating HCC surveillance receipt, or interventions to increase surveillance, in patients with cirrhosis. A pooled estimate for surveillance receipt with 95% confidence intervals was calculated. Correlates of surveillance utilization were defined from each study and pre-specified subgroup analyses. Twenty-nine studies, with a total of 118,799 patients, met inclusion criteria, with a pooled estimate for surveillance utilization of 24.0% (95%CI 18.4 - 30.1). In subgroup analyses, the highest surveillance receipt was reported in studies with patients enrolled from subspecialty Gastroenterology/Hepatology clinics and lowest in studies characterizing surveillance in population-based cohorts (73.7% vs. 8.8%, p<0.001). Commonly reported correlates of surveillance included higher receipt among patients followed by subspecialists and lower receipt among those with alcohol- or NASH-related cirrhosis. All eight studies (n=5229) evaluating interventions including patient/provider education, inreach (e.g. reminder and recall systems), and population health outreach strategies reported significant increases (range 9.4% - 63.6%) in surveillance receipt. CONCLUSION: HCC surveillance continues to remain underused in clinical practice, particularly among patients with alcohol- or NASH-related cirrhosis and those not followed in subspecialty gastroenterology clinics. Interventions such as provider education, inreach including reminder systems and population health outreach efforts can significantly increase HCC surveillance.