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Hepatobiliary Malignancies
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Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States†
Article first published online: 23 FEB 2010
DOI: 10.1002/hep.23615
Copyright © 2010 American Association for the Study of Liver Diseases
Additional Information
How to Cite
Davila, J. A., Morgan, R. O., Richardson, P. A., Du, X. L., McGlynn, K. A. and El-Serag, H. B. (2010), Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States. Hepatology, 52: 132–141. doi: 10.1002/hep.23615
- †
Potential conflict of interest: Nothing to report.
Publication History
- Issue published online: 23 JUN 2010
- Article first published online: 23 FEB 2010
- Manuscript Accepted: 1 FEB 2010
- Manuscript Received: 27 JUL 2009
Funded by
- American Cancer Society. Grant Number: RSGPB-07-010-01-CPHPS
- NCI. Grant Numbers: R01 125487, DK K24 04107
- Houston VA Health Services Research and Development Center of Excellence. Grant Number: HFP90-020
Abstract
Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is recommended but may not be performed. The extent and determinants of HCC surveillance are unknown. We conducted a population-based United States cohort study of patients over 65 years of age to examine use and determinants of prediagnosis surveillance in patients with HCC who were previously diagnosed with cirrhosis. Patients diagnosed with HCC during 1994-2002 were identified from the linked Surveillance, Epidemiology, and End-Results registry–Medicare databases. We identified alpha-fetoprotein (AFP) and ultrasound tests performed for HCC surveillance, and examined factors associated with surveillance. We identified 1,873 HCC patients with a prior diagnosis of cirrhosis. In the 3 years before HCC, 17% received regular surveillance and 38% received inconsistent surveillance. In a subset of 541 patients in whom cirrhosis was recorded for 3 or more years prior to HCC, only 29% received routine surveillance and 33% received inconsistent surveillance. Among all patients who received regular surveillance, approximately 52% received both AFP and ultrasound, 46% received AFP only, and 2% received ultrasound only. Patients receiving regular surveillance were more likely to have lived in urban areas and had higher incomes than those who did not receive surveillance. Before diagnosis, approximately 48% of patients were seen by a gastroenterologist/hepatologist or by a physician with an academic affiliation; they were approximately 4.5-fold and 2.8-fold, respectively, more likely to receive regular surveillance than those seen by a primary care physician only. Geographic variation in surveillance was observed and explained by patient and physician factors. Conclusion: Less than 20% of patients with cirrhosis who developed HCC received regular surveillance. Gastroenterologists/hepatologists or physicians with an academic affiliation are more likely to perform surveillance. HEPATOLOGY 2010