Singal AG, Zhang E, Narasimman M, Rich NE, Waljee AK, Hoshida Y, Yang JD, Reig M, Cabibbo G, Nahon P, Parikh ND, Marrero JA.
J Hepatol. 2022 Feb 6:S0168-8278(22)00068-X. doi: 10.1016/j.jhep.2022.01.023.
Background: There is controversy regarding the overall value of hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis given a lack of randomized controlled data. To address this issue, we conducted a systematic review and meta-analysis of cohort studies evaluating 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 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 with 145,396 patients with HCC, of whom 41,052 (28.2%) were detected by surveillance. 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 (HR 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