HCC Surveillance Inadequate in Patients With Cirrhosis

ISSUE: OCTOBER, 2010
VOLUME: 61:10

David Wild

Less than 20% of older patients with cirrhosis undergo surveillance regularly for hepatocellular carcinoma (HCC), according to a recent review of a large national database (Davila JA et al. Hepatology 2010;52:132-141). One expert believes that physicians and patients should do more to increase HCC vigilance.

“We need a three-pronged educational approach that includes all those involved in managing liver diseases,” said Lewis Roberts, MD, associate professor in the Department of Gastroenterology and Hepatology at Mayo Clinic School of Medicine, in Rochester, Minn. “Primary care physicians need to refer patients appropriately; specialists should initiate treatment and surveillance; and patients need to adhere to the disease management schedule. We know better surveillance equals better outcomes.”

To evaluate HCC surveillance in a large population, senior investigator Hashem El-Serag, MD, MPH, professor of medicine and chief of the Section of Gastroenterology and Hepatology at Baylor College of Medicine, Houston, and colleagues analyzed data from 1,873 cirrhotic patients with a diagnosis of HCC who were enrolled in the Surveillance, Epidemiology and End Results (SEER) program registry and the Medicare database. All subjects were over 65 years of age and had been diagnosed with HCC between 1994 and 2002. To determine the extent of HCC surveillance before diagnosis of the disease, the investigators examined the number of α-fetoprotein (AFP) and ultrasound tests undergone by the patients. They also conducted multiple regression analyses of patient and physician characteristics to establish any correlations with HCC surveillance.

The investigators found that within the three years before diagnosis of HCC, 17% (321 of 1,873) of subjects underwent regular surveillance, defined as an annual AFP or ultrasound test during at least two of the three years, while 38% (710 of 1,873) were administered an AFP or ultrasound test at least once during that period. Furthermore, the investigators found that approximately half (905 of 1,873) of all subjects were seen by a gastroenterologist, hepatologist or both at least once during the three years before HCC diagnosis. Patients in this group were 2.8 times more likely to undergo a regular surveillance regimen than those who were seen only by an internist or a family physician (P<0.001). However, those treated by both a gastroenterologist or hepatologist and an internist or a family physician were 4.5 times more likely to undergo regular HCC surveillance than those who received care by an internist or a family physician alone (P<0.001).

The authors noted that guidelines for HCC management were released from the American Association for the Study of Liver Diseases after the end of their study period in 2001, and that it is possible that HCC surveillance has improved since that time.

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