Melisa Dirchwolf1, Sebastián Marciano2, Andres E Ruf3, Amit G Singal4, Vanina D'Ercole5, Paola Coisson6, Alina Zerega7, Federico Orozco8, Ana Palazzo9, Eduardo Fassio10, Diego Arufe11, Margarita Anders12, Claudia D'Amico13, Luis Gaite14, Marcos Thompson15, Daniela Perez9, Leila Haddad2, Ezequiel Demirdjian11, Moira Zunino9, Adrián Gadano2, María Dolores Murga9, Carla Bermudez2, Jesica Tomatis3, Nadia Grigera12, Florencia Antinucci12, Manuel Baravalle3, Maria Mercedes Rodriguez Gazari16, Melina Ferreiro17, Manuel Barbero6, Andrea Curia17, Manuel Demonte18, Gisela Gualano10. 1. Hospital Privado de Rosario, Rosario, Santa Fe, Argentina. Electronic address: info@unidaddehigado.com.ar. 2. Hospital Italiano de Buenos Aires, CABA, Argentina. 3. Hospital Privado de Rosario, Rosario, Santa Fe, Argentina. 4. Department Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA. 5. Hospital Complejo Médico de la Policía Federal Churruca - Visca, CABA, Argentina. 6. Hospital El Cruce - Néstor Kirchner, Florencio Varela, Buenos Aires, Argentina. 7. Sanatorio Allende, Córdoba, Córdoba, Argentina; Hospital Córdoba, Córdoba, Córdoba, Argentina. 8. Hospital César Milstein, CABA, Argentina. 9. Hospital Ángel C. Padilla, San Miguel de Tucumán, Tucumán, Argentina. 10. Hospital Nacional Prof. Alejandro Posadas, El Palomar, Buenos Aires. Argentina. 11. Sanatorio Sagrado Corazón, CABA, Argentina. 12. Hospital Alemán, CABA, Argentina. 13. Centro Especialidades Médicas Ambulatoria, Mar del Plata, Buenos Aires, Argentina. 14. Hospital José M. Cullen, Santa Fe, Santa Fe, Argentina; Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina. 15. Hospital Universitario Austral, Pilar, Buenos Aires, Argentina. 16. Hospital Británico, CABA, Argentina. 17. Hospital de Clínicas José de San Martín (UBA), CABA, Argentina. 18. Hospital José M. Cullen, Santa Fe, Santa Fe, Argentina.
Abstract
INTRODUCTION AND OBJECTIVES: Failures at any step in the hepatocellular carcinoma (HCC) surveillance process can result in HCC diagnostic delays and associated worse prognosis. We aimed to estimate the prevalence of surveillance failure and its associated risk factors in patients with HCC in Argentina, considering three steps: 1) recognition of at-risk patients, 2) implementation of HCC surveillance, 3) success of HCC surveillance. METHODS: We performed a multi-center cross-sectional study of patients at-risk for HCC in Argentina seen between10.01.2018 and 10.30.2019. Multivariable logistic regression analysis was used to identify correlates of surveillance failure. RESULTS: Of 301 included patients, the majority were male (74.8%) with a mean age of 64 years old. At the time of HCC diagnosis, 75 (25%) patients were unaware of their diagnosis of chronic liver disease, and only 130 (43%) patients were under HCC surveillance. Receipt of HCC surveillance was significantly associated with follow-up by a hepatologist. Of 119 patients with complete surveillance, surveillance failure occurred in 30 (25%) patients. Surveillance failure was significantly associated with alpha fetoprotein ≥20 ng/mL (OR 4.0, CI 95% 1.43-11.55). CONCLUSIONS: HCC surveillance failure was frequent in all the evaluated steps. These data should help guide strategies to improve the implementation and results of HCC surveillance in our country.
INTRODUCTION AND OBJECTIVES: Failures at any step in the hepatocellular carcinoma (HCC) surveillance process can result in HCC diagnostic delays and associated worse prognosis. We aimed to estimate the prevalence of surveillance failure and its associated risk factors in patients with HCC in Argentina, considering three steps: 1) recognition of at-risk patients, 2) implementation of HCC surveillance, 3) success of HCC surveillance. METHODS: We performed a multi-center cross-sectional study of patients at-risk for HCC in Argentina seen between10.01.2018 and 10.30.2019. Multivariable logistic regression analysis was used to identify correlates of surveillance failure. RESULTS: Of 301 included patients, the majority were male (74.8%) with a mean age of 64 years old. At the time of HCC diagnosis, 75 (25%) patients were unaware of their diagnosis of chronic liver disease, and only 130 (43%) patients were under HCC surveillance. Receipt of HCC surveillance was significantly associated with follow-up by a hepatologist. Of 119 patients with complete surveillance, surveillance failure occurred in 30 (25%) patients. Surveillance failure was significantly associated with alpha fetoprotein ≥20 ng/mL (OR 4.0, CI 95% 1.43-11.55). CONCLUSIONS: HCC surveillance failure was frequent in all the evaluated steps. These data should help guide strategies to improve the implementation and results of HCC surveillance in our country.