Feng Su1, Noel S Weiss2, Lauren A Beste3, Andrew M Moon4, Ga-Young Jin5, Pamela Green5, Kristin Berry5, George N Ioannou6. 1. Divisions of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA. 2. Department of Epidemiology, University of Washington, Seattle, WA, USA. 3. Division of General Internal Medicine, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, USA. 4. Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 5. Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA. 6. Divisions of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA, USA; Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA, USA. Electronic address: georgei@medicine.washington.edu.
Abstract
BACKGROUND & AIMS: Patients with chronic hepatitis B (CHB) infection routinely undergo screening for hepatocellular carcinoma (HCC), but the efficacy of screening remains unclear. We aimed to evaluate the impact of screening with ultrasound and/or serum alpha-fetoprotein (AFP) on HCC-related mortality in patients with CHB. METHODS: We performed a matched case-control study of patients with CHB receiving care through the Veterans Affairs (VA) health administration. Cases were patients who died of HCC between 01/01/2004 and 12/31/2017, while controls were patients with CHB who did not die of HCC. Cases were matched to controls by CHB diagnosis date, age, sex, race/ethnicity, cirrhosis, antiviral therapy exposure, hepatitis B e antigen status, and viral load. We identified screening ultrasound and AFPs obtained in the 4 years preceding HCC diagnosis in cases and the equivalent index date in controls. Using conditional logistic regression, we compared cases and controls with respect to receipt of screening. A lower likelihood of screening in cases corresponds to an association between screening and reduced risk of HCC-related mortality. RESULTS: We identified 169 cases, matched to 169 controls. Fewer cases than controls underwent screening with either screening modality (33.7% vs. 58.6%) or both modalities (19.5% vs. 34.4%). In multivariable conditional logistic regression, screening with either modality was associated with a lower risk of HCC-related mortality (adjusted odds ratio [aOR] 0.21, 95% CI 0.09-0.50), as was screening with both modalities (aOR of 0.13; 95% CI 0.04-0.43). CONCLUSIONS: HCC screening was associated with a substantial reduction in HCC-related mortality in VA patients with CHB. LAY SUMMARY: Patients with hepatitis B infection have a high risk of developing liver cancer. It is therefore recommended that they undergo frequent screening for liver cancer, but whether this leads to a lower risk of dying from liver cancer is not clear. In this study, we show that liver cancer screening is associated with a reduction in the mortality from liver cancer in patients with hepatitis B infection.
BACKGROUND & AIMS: Patients with chronic hepatitis B (CHB) infection routinely undergo screening for hepatocellular carcinoma (HCC), but the efficacy of screening remains unclear. We aimed to evaluate the impact of screening with ultrasound and/or serum alpha-fetoprotein (AFP) on HCC-related mortality in patients with CHB. METHODS: We performed a matched case-control study of patients with CHB receiving care through the Veterans Affairs (VA) health administration. Cases were patients who died of HCC between 01/01/2004 and 12/31/2017, while controls were patients with CHB who did not die of HCC. Cases were matched to controls by CHB diagnosis date, age, sex, race/ethnicity, cirrhosis, antiviral therapy exposure, hepatitis B e antigen status, and viral load. We identified screening ultrasound and AFPs obtained in the 4 years preceding HCC diagnosis in cases and the equivalent index date in controls. Using conditional logistic regression, we compared cases and controls with respect to receipt of screening. A lower likelihood of screening in cases corresponds to an association between screening and reduced risk of HCC-related mortality. RESULTS: We identified 169 cases, matched to 169 controls. Fewer cases than controls underwent screening with either screening modality (33.7% vs. 58.6%) or both modalities (19.5% vs. 34.4%). In multivariable conditional logistic regression, screening with either modality was associated with a lower risk of HCC-related mortality (adjusted odds ratio [aOR] 0.21, 95% CI 0.09-0.50), as was screening with both modalities (aOR of 0.13; 95% CI 0.04-0.43). CONCLUSIONS: HCC screening was associated with a substantial reduction in HCC-related mortality in VA patients with CHB. LAY SUMMARY: Patients with hepatitis B infection have a high risk of developing liver cancer. It is therefore recommended that they undergo frequent screening for liver cancer, but whether this leads to a lower risk of dying from liver cancer is not clear. In this study, we show that liver cancer screening is associated with a reduction in the mortality from liver cancer in patients with hepatitis B infection.
Authors: Amit G Singal; Sahil Mittal; Olutola A Yerokun; Chul Ahn; Jorge A Marrero; Adam C Yopp; Neehar D Parikh; Steve J Scaglione Journal: Am J Med Date: 2017-02-14 Impact factor: 4.965
Authors: Andrew M Moon; Noel S Weiss; Lauren A Beste; Feng Su; Samuel B Ho; Ga-Young Jin; Elliott Lowy; Kristin Berry; George N Ioannou Journal: Gastroenterology Date: 2018-07-05 Impact factor: 22.682
Authors: Amit G Singal; Adam Yopp; Celette S Skinner; Milton Packer; William M Lee; Jasmin A Tiro Journal: J Gen Intern Med Date: 2012-01-04 Impact factor: 5.128
Authors: Jung Hee Son; Sang Hyun Choi; So Yeon Kim; Hye Young Jang; Jae Ho Byun; Hyung Jin Won; So Jung Lee; Young Suk Lim Journal: Radiology Date: 2019-06-18 Impact factor: 11.105
Authors: Christoph Spinner; Jörg Janne Vehreschild; Carolin E M Jakob; Stefan Borgmann; Fazilet Duygu; Uta Behrends; Martin Hower; Uta Merle; Anette Friedrichs; Lukas Tometten; Frank Hanses; Norma Jung; Siegbert Rieg; Kai Wille; Beate Grüner; Hartwig Klinker; Nicole Gersbacher-Runge; Kerstin Hellwig; Lukas Eberwein; Sebastian Dolff; Dominic Rauschning; Michael von Bergwelt-Baildon; Julia Lanznaster; Richard Strauß; Janina Trauth; Katja de With; Maria Ruethrich; Catherina Lueck; Jacob Nattermann; Lene Tscharntke; Lisa Pilgram; Sandra Fuhrmann; Annika Classen; Melanie Stecher; Maximilian Schons Journal: Infection Date: 2020-10-01 Impact factor: 7.455