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Author Notes:

E-mail: amit.singal@utsouthwestern.edu

See publication for full list of author contributions.

The content is solely the responsibility of the authors and does not necessarily represent the official views of UT-STAR, the University of Texas Southwestern Medical Center and its affiliated academic and health care centers, the National Center for Advancing Translational Sciences, or the National Institutes of Health.

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors have declared that no competing interests exist.

Subject:

Research Funding:

This work was conducted with support from UT-STAR, NIH/NCATS Grant Number KL2 TR000453, NIH/NCATS Grant UL1-TR000451, and the ACG Junior Faculty Development Award awarded to AS.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Medicine, General & Internal
  • General & Internal Medicine
  • MEDICINE, GENERAL & INTERNAL
  • RANDOMIZED CONTROLLED-TRIAL
  • LIVER-TRANSPLANT CENTER
  • HEPATITIS-C VIRUS
  • EARLY-DIAGNOSIS
  • UNITED-STATES
  • COLORECTAL-CANCER
  • SYSTEMATIC REVIEWS
  • AMERICAN PATIENTS
  • VIRAL-HEPATITIS
  • ASIAN-AMERICANS

Early Detection, Curative Treatment, and Survival Rates for Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis: A Meta-analysis

Tools:

Journal Title:

PLoS Medicine

Volume:

Volume 11, Number 4

Publisher:

, Pages e1001624-e1001624

Type of Work:

Article | Final Publisher PDF

Abstract:

BACKGROUND: Surveillance for hepatocellular carcinoma (HCC) has level I evidence among patients with hepatitis B but only level II evidence in patients with cirrhosis. This lack of randomized data has spurred questions regarding the utility of HCC surveillance in this patient population; however, lack of randomized data does not equate to a lack of data supporting the efficacy of surveillance. The aim of our study was to determine the effect of HCC surveillance on early stage tumor detection, receipt of curative therapy, and overall survival in patients with cirrhosis. METHODS AND FINDINGS: We performed a systematic literature review using Medline from January 1990 through January 2014 and a search of national meeting abstracts from 2009-2012. Two investigators identified studies that reported rates of early stage tumor detection, curative treatment receipt, or survival, stratified by HCC surveillance status, among patients with cirrhosis. Both investigators independently extracted data on patient populations, study methods, and results using standardized forms. Pooled odds ratios, according to HCC surveillance status, were calculated for each outcome using the DerSimonian and Laird method for a random effects model. We identified 47 studies with 15,158 patients, of whom 6,284 (41.4%) had HCC detected by surveillance. HCC surveillance was associated with improved early stage detection (odds ratio [OR] 2.08, 95% CI 1.80-2.37) and curative treatment rates (OR 2.24, 95% CI 1.99-2.52). HCC surveillance was associated with significantly prolonged survival (OR 1.90, 95% CI 1.67-2.17), which remained significant in the subset of studies adjusting for lead-time bias. Limitations of current data included many studies having insufficient duration of follow-up to assess survival and the majority not adjusting for liver function or lead-time bias. CONCLUSIONS: HCC surveillance is associated with significant improvements in early tumor detection, receipt of curative therapy, and overall survival in patients with cirrhosis. Please see later in the article for the Editors' Summary.

Copyright information:

© 2014 Singal et al

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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