Detection of hepatocellular carcinoma at advanced stages among patients in the HALT-C trial

Where did surveillance fail

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106 Citations (Scopus)

Abstract

OBJECTIVES:Only 40% of patients with hepatocellular carcinoma (HCC) are diagnosed at an early stage, suggesting breakdowns in the surveillance process. The aim of our study was to assess the reasons behind surveillance process failures among patients in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial (HALT-C), which prospectively collected HCC surveillance data on a large cohort of patients.METHODS:Binary regression analysis was used to identify predictors of consistent surveillance, which was defined as having an ultrasound and alpha-fetoprotein every 12 months. Surveillance failures among patients who developed HCC were classified into one of three categories: absence of screening, absence of follow-up, or absence of detection.RESULTS:Over a mean follow-up of 6.1 years, 692 (68.9%) of 1,005 patients had consistent surveillance. Study site was the strongest predictor of consistent surveillance (P<0.001). After adjusting for study site, patient-level predictors of consistent surveillance included platelet count >150,000/mm 3 (hazard ratio (HR) 1.28; 95% confidence interval (CI): 1.05-1.56) and complete clinic visit adherence (HR 1.72, 95% CI: 1.11-2.63). Of 83 patients with HCC, 23 (27.7%) were detected beyond Milan criteria. Three (13%) had late-stage HCC due to the absence of screening, 4 (17%) due to the absence of follow-up, and 16 (70%) due to the absence of detection.CONCLUSIONS:Surveillance process failures, including absence of screening or follow-up, are common and potentially contribute to late-stage tumors in one-third of cases. However, the most common reason for finding HCC at a late stage was an absence of detection, suggesting better surveillance strategies are needed.

Original languageEnglish (US)
Pages (from-to)425-432
Number of pages8
JournalAmerican Journal of Gastroenterology
Volume108
Issue number3
DOIs
StatePublished - Mar 2013

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Hepatocellular Carcinoma
Confidence Intervals
alpha-Fetoproteins
Hepatitis C
Ambulatory Care
Antiviral Agents
Fibrosis
Regression Analysis
Neoplasms
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{72a7b5882b344f04a87d90a8f2439f9a,
title = "Detection of hepatocellular carcinoma at advanced stages among patients in the HALT-C trial: Where did surveillance fail",
abstract = "OBJECTIVES:Only 40{\%} of patients with hepatocellular carcinoma (HCC) are diagnosed at an early stage, suggesting breakdowns in the surveillance process. The aim of our study was to assess the reasons behind surveillance process failures among patients in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial (HALT-C), which prospectively collected HCC surveillance data on a large cohort of patients.METHODS:Binary regression analysis was used to identify predictors of consistent surveillance, which was defined as having an ultrasound and alpha-fetoprotein every 12 months. Surveillance failures among patients who developed HCC were classified into one of three categories: absence of screening, absence of follow-up, or absence of detection.RESULTS:Over a mean follow-up of 6.1 years, 692 (68.9{\%}) of 1,005 patients had consistent surveillance. Study site was the strongest predictor of consistent surveillance (P<0.001). After adjusting for study site, patient-level predictors of consistent surveillance included platelet count >150,000/mm 3 (hazard ratio (HR) 1.28; 95{\%} confidence interval (CI): 1.05-1.56) and complete clinic visit adherence (HR 1.72, 95{\%} CI: 1.11-2.63). Of 83 patients with HCC, 23 (27.7{\%}) were detected beyond Milan criteria. Three (13{\%}) had late-stage HCC due to the absence of screening, 4 (17{\%}) due to the absence of follow-up, and 16 (70{\%}) due to the absence of detection.CONCLUSIONS:Surveillance process failures, including absence of screening or follow-up, are common and potentially contribute to late-stage tumors in one-third of cases. However, the most common reason for finding HCC at a late stage was an absence of detection, suggesting better surveillance strategies are needed.",
author = "Singal, {Amit G.} and Mahendra Nehra and Beverley Adams-Huet and Yopp, {Adam C.} and Tiro, {Jasmin A.} and Marrero, {Jorge A.} and Lok, {Anna S.} and Lee, {William M.}",
year = "2013",
month = "3",
doi = "10.1038/ajg.2012.449",
language = "English (US)",
volume = "108",
pages = "425--432",
journal = "American Journal of Gastroenterology",
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TY - JOUR

T1 - Detection of hepatocellular carcinoma at advanced stages among patients in the HALT-C trial

T2 - Where did surveillance fail

AU - Singal, Amit G.

AU - Nehra, Mahendra

AU - Adams-Huet, Beverley

AU - Yopp, Adam C.

AU - Tiro, Jasmin A.

AU - Marrero, Jorge A.

AU - Lok, Anna S.

AU - Lee, William M.

PY - 2013/3

Y1 - 2013/3

N2 - OBJECTIVES:Only 40% of patients with hepatocellular carcinoma (HCC) are diagnosed at an early stage, suggesting breakdowns in the surveillance process. The aim of our study was to assess the reasons behind surveillance process failures among patients in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial (HALT-C), which prospectively collected HCC surveillance data on a large cohort of patients.METHODS:Binary regression analysis was used to identify predictors of consistent surveillance, which was defined as having an ultrasound and alpha-fetoprotein every 12 months. Surveillance failures among patients who developed HCC were classified into one of three categories: absence of screening, absence of follow-up, or absence of detection.RESULTS:Over a mean follow-up of 6.1 years, 692 (68.9%) of 1,005 patients had consistent surveillance. Study site was the strongest predictor of consistent surveillance (P<0.001). After adjusting for study site, patient-level predictors of consistent surveillance included platelet count >150,000/mm 3 (hazard ratio (HR) 1.28; 95% confidence interval (CI): 1.05-1.56) and complete clinic visit adherence (HR 1.72, 95% CI: 1.11-2.63). Of 83 patients with HCC, 23 (27.7%) were detected beyond Milan criteria. Three (13%) had late-stage HCC due to the absence of screening, 4 (17%) due to the absence of follow-up, and 16 (70%) due to the absence of detection.CONCLUSIONS:Surveillance process failures, including absence of screening or follow-up, are common and potentially contribute to late-stage tumors in one-third of cases. However, the most common reason for finding HCC at a late stage was an absence of detection, suggesting better surveillance strategies are needed.

AB - OBJECTIVES:Only 40% of patients with hepatocellular carcinoma (HCC) are diagnosed at an early stage, suggesting breakdowns in the surveillance process. The aim of our study was to assess the reasons behind surveillance process failures among patients in the Hepatitis C Antiviral Long-Term Treatment against Cirrhosis Trial (HALT-C), which prospectively collected HCC surveillance data on a large cohort of patients.METHODS:Binary regression analysis was used to identify predictors of consistent surveillance, which was defined as having an ultrasound and alpha-fetoprotein every 12 months. Surveillance failures among patients who developed HCC were classified into one of three categories: absence of screening, absence of follow-up, or absence of detection.RESULTS:Over a mean follow-up of 6.1 years, 692 (68.9%) of 1,005 patients had consistent surveillance. Study site was the strongest predictor of consistent surveillance (P<0.001). After adjusting for study site, patient-level predictors of consistent surveillance included platelet count >150,000/mm 3 (hazard ratio (HR) 1.28; 95% confidence interval (CI): 1.05-1.56) and complete clinic visit adherence (HR 1.72, 95% CI: 1.11-2.63). Of 83 patients with HCC, 23 (27.7%) were detected beyond Milan criteria. Three (13%) had late-stage HCC due to the absence of screening, 4 (17%) due to the absence of follow-up, and 16 (70%) due to the absence of detection.CONCLUSIONS:Surveillance process failures, including absence of screening or follow-up, are common and potentially contribute to late-stage tumors in one-third of cases. However, the most common reason for finding HCC at a late stage was an absence of detection, suggesting better surveillance strategies are needed.

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U2 - 10.1038/ajg.2012.449

DO - 10.1038/ajg.2012.449

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VL - 108

SP - 425

EP - 432

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 3

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