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Impact of hepatocellular carcinoma aetiology and liver function on the benefit of surveillance: A novel approach for the adjustment of lead‐time bias
Author(s) -
Toyoda Hidenori,
Kumada Takashi,
Tada Toshifumi,
Mizuno Kazuyuki,
Hiraoka Atsushi,
Tsuji Kunihiko,
Ishikawa Toru,
Akita Tomoyuki,
Tanaka Junko
Publication year - 2018
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.13927
Subject(s) - hepatocellular carcinoma , medicine , etiology , liver function , survival analysis , survival rate , gastroenterology , oncology
Background & Aims Surveillance reportedly has benefit on survival in patients with hepatocellular carcinoma ( HCC ), even after adjustment for lead‐time bias. However, previous adjustment for lead‐time bias using tumour volume doubling time ( TVDT ) had inherent problem in accuracy. We evaluated survival benefit of HCC surveillance with newly developed approach for adjusting lead‐time bias. In addition, survival benefit was evaluated according to HCC aetiology and liver function. Methods A total of 3899 patients were studied. TVDT was calculated in 255 study patients with ≥2 tumour size measurements before the diagnosis of HCC . Adjusted survival time was calculated based on TVDT , as the time from when HCC was assumed to be 5 mm to death or last follow‐up. Survival rates based on this adjusted survival time were compared between the surveillance and nonsurveillance groups and categorized by HCC aetiology and liver function. Results Calculated TVDT varied widely by study patients (median 141.9, IQR , 73.1‐261.7 days). Survival rates based on adjusted survival time were higher in the surveillance group overall and by patients HCC aetiology. Whereas adjusted survival rates were higher in the surveillance group in Child‐Pugh class A patients, the survival benefit was smaller in Child‐Pugh class B patients and not statistically significant in Child‐Pugh class C patients. Conclusions The survival benefit of surveillance for patients with HCC was demonstrated after adjustment for lead‐time bias with novel, more accurate methodology. However, the benefits differed based on liver function and may vary largely by patients because of wide variation in TVDT .