Surveillance for hepatocellular carcinoma with a 3-months interval in "extremely high-risk" patients does not further improve survival

Dig Liver Dis. 2022 Jul;54(7):927-936. doi: 10.1016/j.dld.2021.08.025. Epub 2021 Sep 25.


Background: An enhanced surveillance schedule has been proposed for cirrhotics with viral etiology, who are considered at extremely high-risk of hepatocellular carcinoma (HCC).

Aims: We compared the 3- and 6-months surveillance interval, evaluating cancer stage at diagnosis and patient survival.

Methods: Data of 777 HBV and HCV cirrhotic patients with HCC diagnosed under a 3-months (n = 109, 3MS group) or a 6-months (n = 668, 6MS group) surveillance were retrieved from the Italian Liver Cancer database. Survival in the 3MS group was considered as observed and adjusted for lead-time bias, and survival analysis was repeated after a propensity score matching.

Results: The 3-months surveillance interval neither reduced the share of patients diagnosed outside the Milano criteria, nor increased their probability to receive curative treatments. The median survival of 6MS patients (55.0 months [45.9-64.0]) was not significantly different from the observed (47.0 months [35.0-58.9]; p = 0.43) and adjusted (44.9 months [33.4-56.4]; p = 0.30) survival of 3MS patients. A propensity score analysis confirmed the absence of a survival advantage for 3MS patients.

Conclusions: A tightening of surveillance schedule does not increase the diagnosis of early-stage tumors, the feasibility of curative treatments and the survival. Therefore, we should maintain the 6-months interval in the surveillance of viral cirrhotics.

Keywords: Cancer stage; Hepatocellular carcinoma; Surveillance interval; Survival.

MeSH terms

  • Carcinoma, Hepatocellular* / pathology
  • Humans
  • Liver Neoplasms* / therapy
  • Propensity Score
  • Survival Analysis