Impact of Surveillance for Hepatocellular Carcinoma on Survival in Patients with Compensated Cirrhosis

Abstract

Surveillance for hepatocellular carcinoma (HCC) has been recommended in patients with cirrhosis. In this work, we examine the extent to which the competing risk of hepatic decompensation influences the benefit of HCC surveillance, by investigating the impact of availability of liver transplantation (LTx) and rate of progression of hepatic decompensation on survival gain from HCC surveillance. A multistate Markov model was constructed simulating a cohort of 50-year old patients with compensated cirrhosis. The primary outcome of interest was all-cause and HCC-specific mortality. The main input data included incidence of HCC, sensitivity of screening test, and mortality from hepatic decompensation. Treatment modalities modeled included LTx, resection, and radiofrequency ablation. In the base case scenario, LTx would be available to rescue a proportion of patient from deaths. In the absence of surveillance, 68.2% of the cohort members died by 15 years, which was from HCC in 25.1% and from hepatic decompensation in 43.6% of decedents. With surveillance, the median survival improved from 10.4 years to 11.2 years. The number needed to be under surveillance to reduce one all- cause and HCC-specific death over 15 years was 28 and 18, respectively. In sensitivity analyses, incidence of HCC and progression of cirrhosis had the strongest effect on the benefit of surveillance, whereas LTx availability had negligible impact.

CONCLUSIONS: HCC surveillance decreases all-cause and tumor-specific mortality in patients with compensated cirrhosis regardless of LTx availability. In addition, incidence of HCC and sensitivity of surveillance test also had a substantial impact on the benefits of surveillance. This article is protected by copyright. All rights reserved.

http://ift.tt/2ziH0DC