Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival among Patients with Cirrhosis in the United States

Abstract Background Professional societies recommend hepatocellular carcinoma screening in patients with cirrhosis but high-quality data evaluating its effectiveness to improve early tumor detection and survival in “real world” clinical practice are needed. Aims Characterize the association between hepatocellular carcinoma screening and early tumor detection, curative treatment, and overall survival among patients with cirrhosis. Methods We performed a retrospective cohort study of patients diagnosed with hepatocellular carcinoma between June 2012 and May 2013 at four health systems in the United States. Patients were categorized in the screening group if hepatocellular carcinoma was detected by imaging performed for screening purposes. Generalized linear models and multivariate Cox regression with frailty adjustment were used to compare early detection, curative treatment, and survival between screen-detected and non-screen detected patients. Results Among 374 hepatocellular carcinoma patients, 42% (n=157) were detected by screening. Screen-detected patients had a significantly higher proportion of early tumors (BCLC stage A 63.1% vs. 36.4%, p