The clinical and financial burden of nonhepatocellular carcinoma focal lesions detected during surveillance of patients with cirrhosis

Nahon P, Layese R, Ganne-Carrié N, Moins C, N’Kontchou G, Chaffaut C, Ronot M, Audureau E, Durand-Zaleski I, Natella PA; ANRS CO12 CirVir and CIRRAL groups. Hepatology. 2023 Sep 29. doi: 10.1097/HEP.0000000000000615.

Background and aims: Hepatocellular carcinoma (HCC) surveillance is challenged by the detection of hepatic focal lesions (HFLs) of other types. This study aimed to describe the incidence, characteristics, outcomes and costs of non-HCC HFL detected during surveillance.

Approach and results: We retrospectively analyzed non-standardized workup performed in French patients included in HCC surveillance programs recruited in 57 French tertiary centres (ANRS CirVir and CIRRAL cohorts, HCC 2000 trial). The overall cost of workup was evaluated, with an estimation of an average cost per patient for the entire population and per lesion detected. A total of 3295 patients were followed up for 59.8 months, 391 (11.9%) patients developed HCCs (5-year incidence: 12.1%), and 633 (19.2%) developed non-HCC HFLs (5-year incidence: 21.8%). Characterization of non-HCC HFL required a median additional of 0.7 exams per year. A total of 11.8% of non-HCC HFLs were not confirmed on recall procedures, and 19.6% of non-HCC HFLs remained undetermined. A definite diagnosis of benign liver lesions was made in 65.1%, malignant tumours were diagnosed in 3.5%. The survival of patients with benign or undetermined non-HCC HFL was similar to that of patients who never developed any HFL (5-year survival 92% vs. 88%, p=0.07). The average cost of the diagnostic workup was 1,087€ for non-HCC HFL and €1,572 for HCC.

Conclusions: Non-HCC HFL are frequently detected in patients with cirrhosis, do not impact prognosis but trigger substantial costs. This burden must be considered in cost-effectiveness analyses of future personalized surveillance strategies.

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