Premium
Postoperative imaging surveillance for hepatocellular carcinoma: How much is enough?
Author(s) -
Mirdad Rayyan S.,
Madison Hyer J.,
Diaz Adrian,
Tsilimigras Diamantis I.,
Azap Rosevine A.,
Paro Alessandro,
Pawlik Timothy M.
Publication year - 2021
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26433
Subject(s) - medicine , hepatocellular carcinoma , odds ratio , confidence interval , hepatitis c , intensity (physics) , hepatitis b , gastroenterology , radiology , quantum mechanics , physics
Background The objective of the current study was to define trends in postoperative surveillance imaging following liver‐directed treatment of hepatocellular carcinoma (HCC), and characterize the impact of high‐intensity surveillance on long‐term survival. Methods Patients who underwent liver‐ directed therapy for HCC between 2004 and 2016 were identified using the SEER‐Medicare database. Trends in surveillance intensity over time, factors associated with high surveillance intensity and the impact of surveillance on long‐term outcomes were examined. Results Utilization of high‐intensity surveillance abdominal imaging (≥6 scans over 2 years) following liver‐directed therapy of HCC decreased over time (2004–2007: n = 130, 36.1% vs. 2008–2011: n = 181, 29.5% vs. 2012–2016: n = 111, 24.5%; p trend < 0.001). History of chronic viral hepatitis (hepatitis B: odds ratio [OR], 1.98; 95% confidence interval [CI]: 1.15–3.43; hepatitis C: OR, 1.79; 95% CI: 1.32–2.43), presence of regional (vs. local‐only) disease (OR, 1.47; 95% CI: 1.09–1.98) and receipt of transplantation (OR, 2.23; 95% CI: 1.57–3.17) were associated with higher odds of high intensity surveillance. Intensity of surveillance imaging was not associated with long‐term survival (5‐year overall survival: low‐intensity, 48.1% vs. high‐intensity, 48.9%; hazards ratio, 0.94; 95% CI: 0.78‐1.13). Conclusion Utilization of posttreatment surveillance imaging decreased over time following liver‐directed therapy for HCC. While utilization of high‐intensity screening varied by HCC procedure performed, intensity of surveillance had no effect on survival.