November 21, 2013

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 Mourad1,2, Sylvie Deuffic-Burban1,2,*, Nathalie Ganne-Carrié3, Thibaud Renaut-Vantroys4, Isabelle Rosa5, Anne-Marie Bouvier6, Guy Launoy7, Stephane Cattan4, Alexandre Louvet1,4, Sébastien Dharancy1,4, Jean-Claude Trinchet3,  Yazdan Yazdanpanah2,8, Philippe Mathurin1,4,*

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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