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...
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| creator | Singal, Amit G., MD MS Mittal, Sahil, MD Yerokun, Olutola A., BS Ahn, Chul, PhD Marrero, Jorge, MD MS Yopp, Adam, MD Parikh, Neehar D., MD MS Scaglione, Steve J., MD |
| description | 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 |
| doi_str_mv | 10.1016/j.amjmed.2017.01.021 |
| format | Article |
| fullrecord | <record><control><sourceid>elsevier</sourceid><recordid>TN_cdi_elsevier_clinicalkeyesjournals_1_s2_0_S0002934317301286</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0002934317301286</els_id><sourcerecordid>1_s2_0_S0002934317301286</sourcerecordid><originalsourceid>FETCH-elsevier_clinicalkeyesjournals_1_s2_0_S00029343173012863</originalsourceid><addsrcrecordid>eNqlj01OwzAUhL0AifJzAxbvAg12AindIKFSVHZIKevoyXmQF_xT2U5Qj8GNcQQ3YDUaaeYbjRDXShZKqvpmKNAOlrqilGpVSFXIUp2IhZSyXK6r2-pMnMc4ZCvXd_VCfO_ogMlrMmY0GGCDQbPzFqHRgcix-4DHGL1mTNTBF6cethjMEfaj9QGeKJFO7B2g6-DFHoKfcq4Zw8QTGkDrM-EVE5NL8be_4RB6HzkCO0g9wZvjGd6kvBEvxek7mkhXf3ohHp63-81uSdlMTKHVhh1rNJ90pDj4Mbica1Uby1a2zfx0PqpWlVTlfV39G_ADyI5vyA</addsrcrecordid><sourcetype>Publisher</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival among Patients with Cirrhosis in the United States</title><source>Elsevier ScienceDirect Journals</source><creator>Singal, Amit G., MD MS ; Mittal, Sahil, MD ; Yerokun, Olutola A., BS ; Ahn, Chul, PhD ; Marrero, Jorge, MD MS ; Yopp, Adam, MD ; Parikh, Neehar D., MD MS ; Scaglione, Steve J., MD</creator><creatorcontrib>Singal, Amit G., MD MS ; Mittal, Sahil, MD ; Yerokun, Olutola A., BS ; Ahn, Chul, PhD ; Marrero, Jorge, MD MS ; Yopp, Adam, MD ; Parikh, Neehar D., MD MS ; Scaglione, Steve J., MD</creatorcontrib><description>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<0.001) and were more likely to undergo curative treatment (31% vs. 13%, p=0.02). hepatocellular carcinoma screening was significantly associated with improved survival in multivariate analysis (HR 0.41, 95%CI 0.26-0.65) after adjusting for patient demographics, Child Pugh class, and performance status. Median survival of screen-detected patients was 14.6 months, compared to 6.0 months for non-screen detected patients, with the difference remaining significant after adjusting for lead-time bias (HR 0.59, 95%CI 0.37-0.93). Conclusion Hepatocellular carcinoma screening is associated with increased early tumor detection and improved survival; however, a minority of hepatocellular carcinoma patients are detected by screening. Interventions to increase screening use in patients with cirrhosis may help curb hepatocellular carcinoma mortality rates.</description><identifier>ISSN: 0002-9343</identifier><identifier>DOI: 10.1016/j.amjmed.2017.01.021</identifier><language>eng</language><subject>Internal Medicine</subject><ispartof>The American journal of medicine, 2017</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4010,27900,27901,27902</link.rule.ids></links><search><creatorcontrib>Singal, Amit G., MD MS</creatorcontrib><creatorcontrib>Mittal, Sahil, MD</creatorcontrib><creatorcontrib>Yerokun, Olutola A., BS</creatorcontrib><creatorcontrib>Ahn, Chul, PhD</creatorcontrib><creatorcontrib>Marrero, Jorge, MD MS</creatorcontrib><creatorcontrib>Yopp, Adam, MD</creatorcontrib><creatorcontrib>Parikh, Neehar D., MD MS</creatorcontrib><creatorcontrib>Scaglione, Steve J., MD</creatorcontrib><title>Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival among Patients with Cirrhosis in the United States</title><title>The American journal of medicine</title><description>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<0.001) and were more likely to undergo curative treatment (31% vs. 13%, p=0.02). hepatocellular carcinoma screening was significantly associated with improved survival in multivariate analysis (HR 0.41, 95%CI 0.26-0.65) after adjusting for patient demographics, Child Pugh class, and performance status. Median survival of screen-detected patients was 14.6 months, compared to 6.0 months for non-screen detected patients, with the difference remaining significant after adjusting for lead-time bias (HR 0.59, 95%CI 0.37-0.93). Conclusion Hepatocellular carcinoma screening is associated with increased early tumor detection and improved survival; however, a minority of hepatocellular carcinoma patients are detected by screening. Interventions to increase screening use in patients with cirrhosis may help curb hepatocellular carcinoma mortality rates.</description><subject>Internal Medicine</subject><issn>0002-9343</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid/><recordid>eNqlj01OwzAUhL0AifJzAxbvAg12AindIKFSVHZIKevoyXmQF_xT2U5Qj8GNcQQ3YDUaaeYbjRDXShZKqvpmKNAOlrqilGpVSFXIUp2IhZSyXK6r2-pMnMc4ZCvXd_VCfO_ogMlrMmY0GGCDQbPzFqHRgcix-4DHGL1mTNTBF6cethjMEfaj9QGeKJFO7B2g6-DFHoKfcq4Zw8QTGkDrM-EVE5NL8be_4RB6HzkCO0g9wZvjGd6kvBEvxek7mkhXf3ohHp63-81uSdlMTKHVhh1rNJ90pDj4Mbica1Uby1a2zfx0PqpWlVTlfV39G_ADyI5vyA</recordid><startdate>2017</startdate><enddate>2017</enddate><creator>Singal, Amit G., MD MS</creator><creator>Mittal, Sahil, MD</creator><creator>Yerokun, Olutola A., BS</creator><creator>Ahn, Chul, PhD</creator><creator>Marrero, Jorge, MD MS</creator><creator>Yopp, Adam, MD</creator><creator>Parikh, Neehar D., MD MS</creator><creator>Scaglione, Steve J., MD</creator><scope/></search><sort><creationdate>2017</creationdate><title>Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival among Patients with Cirrhosis in the United States</title><author>Singal, Amit G., MD MS ; Mittal, Sahil, MD ; Yerokun, Olutola A., BS ; Ahn, Chul, PhD ; Marrero, Jorge, MD MS ; Yopp, Adam, MD ; Parikh, Neehar D., MD MS ; Scaglione, Steve J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-elsevier_clinicalkeyesjournals_1_s2_0_S00029343173012863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Internal Medicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Singal, Amit G., MD MS</creatorcontrib><creatorcontrib>Mittal, Sahil, MD</creatorcontrib><creatorcontrib>Yerokun, Olutola A., BS</creatorcontrib><creatorcontrib>Ahn, Chul, PhD</creatorcontrib><creatorcontrib>Marrero, Jorge, MD MS</creatorcontrib><creatorcontrib>Yopp, Adam, MD</creatorcontrib><creatorcontrib>Parikh, Neehar D., MD MS</creatorcontrib><creatorcontrib>Scaglione, Steve J., MD</creatorcontrib><jtitle>The American journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Singal, Amit G., MD MS</au><au>Mittal, Sahil, MD</au><au>Yerokun, Olutola A., BS</au><au>Ahn, Chul, PhD</au><au>Marrero, Jorge, MD MS</au><au>Yopp, Adam, MD</au><au>Parikh, Neehar D., MD MS</au><au>Scaglione, Steve J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival among Patients with Cirrhosis in the United States</atitle><jtitle>The American journal of medicine</jtitle><date>2017</date><risdate>2017</risdate><issn>0002-9343</issn><abstract>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<0.001) and were more likely to undergo curative treatment (31% vs. 13%, p=0.02). hepatocellular carcinoma screening was significantly associated with improved survival in multivariate analysis (HR 0.41, 95%CI 0.26-0.65) after adjusting for patient demographics, Child Pugh class, and performance status. Median survival of screen-detected patients was 14.6 months, compared to 6.0 months for non-screen detected patients, with the difference remaining significant after adjusting for lead-time bias (HR 0.59, 95%CI 0.37-0.93). Conclusion Hepatocellular carcinoma screening is associated with increased early tumor detection and improved survival; however, a minority of hepatocellular carcinoma patients are detected by screening. Interventions to increase screening use in patients with cirrhosis may help curb hepatocellular carcinoma mortality rates.</abstract><doi>10.1016/j.amjmed.2017.01.021</doi></addata></record> |
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| title | Hepatocellular Carcinoma Screening Associated with Early Tumor Detection and Improved Survival among Patients with Cirrhosis in the United States |
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