Amit G Singal1, Emily Zhang2, Manasa Narasimman2, Nicole E Rich2, Akbar K Waljee3, Yujin Hoshida2, Ju Dong Yang4, Maria Reig5, Giuseppe Cabibbo6, Pierre Nahon7, Neehar D Parikh3, Jorge A Marrero8. 1. Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States. Electronic address: amit.singal@utsouthwestern.edu. 2. Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States. 3. Department of Internal Medicine, University of Michigan, Ann Arbor MI, United States. 4. Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai, Los Angeles, CA, United States. 5. Barcelona Clinic Liver Cancer (BCLC) Group, Hospital Clinic de Barcelona, CIBEREEHD, Barcelona University, Barcelona, Spain. 6. Section of Gastroenterology & Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy. 7. AP-HP, Hôpital Avicenne, Liver Unit, Université Sorbonne Paris Nord, Bobigny, France; Inserm, UMR-1138 Université de Paris, Paris, France. 8. Department of Internal Medicine, University of Pennsylvania, Philadelphia PA, United States.
Abstract
BACKGROUND & AIMS: There is controversy regarding the overall value of hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis given the lack of data from randomized-controlled trials. To address this issue, we conducted a systematic review and meta-analysis of cohort studies evaluating the benefits and harms of HCC surveillance in patients with cirrhosis. METHODS: We performed a search of the Medline and EMBASE databases and national meeting abstracts from January 2014 through July 2020 for studies reporting early-stage HCC detection, curative treatment receipt, or overall survival, stratified by HCC surveillance status, among patients with cirrhosis. Pooled risk ratios (RRs) and hazard ratios, according to HCC surveillance status, were calculated for each outcome using the DerSimonian and Laird method for random effects models. RESULTS: We identified 59 studies including 145,396 patients with HCC, which was detected by surveillance in 41,052 (28.2%) cases. HCC surveillance was associated with improved early-stage detection (RR 1.86, 95% CI 1.73-1.98; I2 = 82%), curative treatment receipt (RR 1.83, 95% CI 1.69-1.97; I2 = 75%), and overall survival (hazard ratio 0.67, 95% CI 0.61-0.72; I2 = 78%) after adjusting for lead-time bias; however, there was notable heterogeneity in all pooled estimates. Four studies examined surveillance-related physical harms due to false positive or indeterminate surveillance results, but no studies examined potential financial or psychological harms. The proportion of patients experiencing surveillance-related physical harms ranged from 8.8% to 27.5% across studies, although most harms were mild in severity. CONCLUSION: HCC surveillance is associated with improved early detection, curative treatment receipt, and survival in patients with cirrhosis, although there was heterogeneity in pooled estimates. Available data suggest HCC surveillance is of high value in patients with cirrhosis, although continued rigorous studies evaluating benefits and harms are still needed. LAY SUMMARY: There has been ongoing debate about the overall value of hepatocellular carcinoma (HCC) screening in patients with cirrhosis given the lack of data from randomized-controlled trials. In a systematic review of contemporary cohort studies, we found that HCC screening is associated with improved early detection, curative treatment receipt, and survival in patients with cirrhosis, although there were fewer data quantifying potential screening-related harms. Available data suggest HCC screening is of high value in patients with cirrhosis, although continued studies evaluating benefits and harms are still needed.
BACKGROUND & AIMS: There is controversy regarding the overall value of hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis given the lack of data from randomized-controlled trials. To address this issue, we conducted a systematic review and meta-analysis of cohort studies evaluating the benefits and harms of HCC surveillance in patients with cirrhosis. METHODS: We performed a search of the Medline and EMBASE databases and national meeting abstracts from January 2014 through July 2020 for studies reporting early-stage HCC detection, curative treatment receipt, or overall survival, stratified by HCC surveillance status, among patients with cirrhosis. Pooled risk ratios (RRs) and hazard ratios, according to HCC surveillance status, were calculated for each outcome using the DerSimonian and Laird method for random effects models. RESULTS: We identified 59 studies including 145,396 patients with HCC, which was detected by surveillance in 41,052 (28.2%) cases. HCC surveillance was associated with improved early-stage detection (RR 1.86, 95% CI 1.73-1.98; I2 = 82%), curative treatment receipt (RR 1.83, 95% CI 1.69-1.97; I2 = 75%), and overall survival (hazard ratio 0.67, 95% CI 0.61-0.72; I2 = 78%) after adjusting for lead-time bias; however, there was notable heterogeneity in all pooled estimates. Four studies examined surveillance-related physical harms due to false positive or indeterminate surveillance results, but no studies examined potential financial or psychological harms. The proportion of patients experiencing surveillance-related physical harms ranged from 8.8% to 27.5% across studies, although most harms were mild in severity. CONCLUSION: HCC surveillance is associated with improved early detection, curative treatment receipt, and survival in patients with cirrhosis, although there was heterogeneity in pooled estimates. Available data suggest HCC surveillance is of high value in patients with cirrhosis, although continued rigorous studies evaluating benefits and harms are still needed. LAY SUMMARY: There has been ongoing debate about the overall value of hepatocellular carcinoma (HCC) screening in patients with cirrhosis given the lack of data from randomized-controlled trials. In a systematic review of contemporary cohort studies, we found that HCC screening is associated with improved early detection, curative treatment receipt, and survival in patients with cirrhosis, although there were fewer data quantifying potential screening-related harms. Available data suggest HCC screening is of high value in patients with cirrhosis, although continued studies evaluating benefits and harms are still needed.
Authors: Nicole E Rich; Binu V John; Neehar D Parikh; Ian Rowe; Neil Mehta; Gaurav Khatri; Smitha M Thomas; Munazza Anis; Mishal Mendiratta-Lala; Christopher Hernandez; Mobolaji Odewole; Latha T Sundaram; Venkata R Konjeti; Shishir Shetty; Tahir Shah; Hao Zhu; Adam C Yopp; Yujin Hoshida; Francis Y Yao; Jorge A Marrero; Amit G Singal Journal: Hepatology Date: 2020-10-25 Impact factor: 17.425
Authors: Neehar D Parikh; Anand S Mehta; Amit G Singal; Timothy Block; Jorge A Marrero; Anna S Lok Journal: Cancer Epidemiol Biomarkers Prev Date: 2020-04-01 Impact factor: 4.254
Authors: Amit G Singal; Sruthi Patibandla; Joseph Obi; Hannah Fullington; Neehar D Parikh; Adam C Yopp; Jorge A Marrero Journal: Clin Gastroenterol Hepatol Date: 2020-09-10 Impact factor: 13.576
Authors: Neehar D Parikh; Nabihah Tayob; Taim Al-Jarrah; Jennifer Kramer; Jennifer Melcher; Donna Smith; Patrick Marquardt; Po-Hong Liu; Runlong Tang; Fasiha Kanwal; Amit G Singal Journal: JAMA Netw Open Date: 2022-07-01
Authors: Eleonora Feletto; Ankur Kohar; David Mizrahi; Paul Grogan; Julia Steinberg; Clare Hughes; Wendy L Watson; Karen Canfell; Xue Qin Yu Journal: Lancet Reg Health West Pac Date: 2022-09-06
Authors: Amit G Singal; Benjamin Haaland; Neehar D Parikh; A Burak Ozbay; Carol Kirshner; Shubham Chakankar; Kyle Porter; Jagpreet Chhatwal; Turgay Ayer Journal: Hepatol Commun Date: 2022-08-09