HCC screening in patients with compensated HCV-related cirrhosis aware of their HCV-status improves survival: A modeling approach

Hepatology

Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

Original Article

Abbas Mourad^1,2, Sylvie Deuffic-Burban^1,2,*, Nathalie Ganne-Carrié³, Thibaud Renaut-Vantroys⁴, Isabelle Rosa⁵, Anne-Marie Bouvier⁶, Guy Launoy⁷, Stephane Cattan⁴, Alexandre Louvet^1,4, Sébastien Dharancy^1,4, Jean-Claude Trinchet³,  Yazdan Yazdanpanah^2,8, Philippe Mathurin^1,4,*

DOI: 10.1002/hep.26944

Copyright © 2013 American Association for the Study of Liver Diseases

Publication History
Accepted manuscript online: 21 NOV 2013 02:20AM EST
Manuscript Accepted: 18 NOV 2013
Manuscript Revised: 31 OCT 2013
Manuscript Received: 9 JUN 2013

Keywords: Lead-time bias;  Life expectancy;  Liver cancer;  Markov model

Abstract

Because of the ongoing debate on the benefit of ultrasound (US) screening for HCC, we assessed the impact of screening on HCV-related compensated cirrhosis aware of their HCV status. A Markov model simulated progression from HCC diagnosis to death in 700 patients with HCV-related compensated cirrhosis aware of their HCV status to estimate life expectancy (LE) and cumulative death at 5 years. Five scenarios were compared: S1, no screening; S2, screening by currently existing practices (57% access and effectiveness leading to the diagnosis of 42% at stage BCLC-0/A); S3, S2 with increased access (97%); S4, S2 with an efficacy of screening close to that achieved in a randomized controlled trial leading to the diagnosis of 87% of patients at stage BCLC-0/A; S5, S3+S4. The analysis was corrected for lead-time bias. Currently existing practices of HCC screening increased LE by 11 months and reduced HCC mortality at 5 years by 6% compared to no screening (P=0.0013). Compared to current screening practices we found that: a) increasing the rate of access to screening would increase the LE by 7 months and reduced HCC mortality at 5 years by 5% (P= 0.045); b) optimal screening would increase the LE by 14 months and reduced HCC mortality at 5 years by 9% (P=0.0002); c) combination of an increased rate of access and optimal effectiveness of HCC screening would increase the LE by 31 months and decreased HCC mortality at 5 years by 20% (P<0.001). Conclusion: The present study shows that US screening for HCC in patients with compensated HCV-related cirrhosis aware of their HCV status improves survival and emphasizes the crucial role of screening effectiveness. (Hepatology 2013;)

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