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Incidence and risk factors associated with hepatocellular carcinoma surveillance failure
Author(s) -
Mancebo Alejo,
Varela María,
GonzálezDiéguez María Luisa,
Navascués Carmen A,
Cadahía Valle,
MesaÁlvarez Alicia,
Rodrigo Luis,
Rodríguez Manuel
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14108
Subject(s) - medicine , hepatocellular carcinoma , hazard ratio , confidence interval , incidence (geometry) , univariate analysis , gastroenterology , milan criteria , multivariate analysis , stage (stratigraphy) , surgery , liver transplantation , transplantation , physics , optics , paleontology , biology
Background and Aim Surveillance for hepatocellular carcinoma (HCC) intends to detect tumors at an early stage to improve survival. The study aims were to assess the frequency and risk factors associated with HCC surveillance failure. Methods The study analyzed data from 188 consecutive patients diagnosed with HCC within a surveillance program conducted among 1,242 cirrhotic patients and based on ultrasonography and alpha‐fetoprotein (AFP) testing every 3 or 6 months. Program failure was defined as the detection of HCC exceeding the Milan criteria. Variables recorded at entry into the program, during follow‐up and at HCC diagnosis, were analyzed. Results At diagnosis, 50 (26.6%) HCC tumors were beyond the Milan criteria. In univariate analysis, Child‐Pugh B at entry ( P = 0.03), development of complications of portal hypertension before tumor diagnosis ( P = 0.03), and failure to complete the prior screening round ( P = 0.02), Child‐Pugh B/C ( P = 0.001) and AFP ≥ 100 ng/mL ( P = 0.03) at diagnosis, were associated with failure. In multivariate analysis, only Child‐Pugh B/C (hazard ratio, 3.18; 95% confidence interval, 1.66–6.10, P < 0.001) and AFP ≥ 100 ng/mL, both at diagnosis (hazard ratio, 2.80; 95% confidence interval, 1.37–5.71, P = 0.005), were independently associated with failure. Survival was higher among patients with tumors within the Milan criteria than those with program failure (33.9 vs 7.6 months, P < 0.001). Conclusions Approximately 25% of HCC cases diagnosed among patients included in a surveillance program were beyond the Milan criteria. Child‐Pugh B/C and AFP ≥ 100 ng/mL at diagnosis were associated with program failure. However, Child‐Pugh B at entry and development of liver‐related complications during follow‐up can be early predictors of failure.