Research Fellow Boston Medical Center Boston, Massachusetts, United States
Disclosure: Disclosure information not submitted.
Participants should be aware of the following financial/non-financial relationships:
Marianna V. Papageorge, MD: Disclosure information not submitted.
Introduction: The timing and frequency of imaging plays a critical role in the diagnosis of hepatocellular carcinoma (HCC). Despite the importance of screening in the management of HCC, not all patients undergo routine surveillance. This study aims to evaluate surveillance patterns and associated survival among patients with HCC.
Methods: Patients with screening-eligible HCC who underwent imaging with ultrasound or abdominal MRI within two years of HCC diagnosis were identified from SEER-Medicare (2008-2015). Surveillance was defined by three cohorts: diagnostic (imaging only within 3 months prior to HCC diagnosis), intermittent (imaging only once within two years prior to HCC diagnosis, excluding diagnostic timeframe) and routine (at least two images within two years prior to HCC diagnosis). Multivariable logistic regression, adjusted for age, sex, race, Elixhauser score and region, was used to predict early stage diagnosis (stage I-II). Survival was evaluated using the Kaplan-Meier and Accelerated Failure Time methods.
Results: A total of 3079 patients were identified: 32.1% diagnostic, 16.8% intermittent and 51.2% routine surveillance. Median age was 73 years [IQR 69, 78], and the majority of patients had a diagnosis of cirrhosis (90.4%). Among patients who underwent routine surveillance, the median number of images performed was 4 [IQR 3, 6]. Routine and intermittent surveillance, as compared to diagnostic, were predictive of early stage disease (routine: OR 2.29, 95%CI 1.91-2.74; intermittent: OR 1.44, 95%CI 1.15-1.81). Patients who underwent routine surveillance had a median overall survival of 20.2 months (versus intermittent 14.0 months, diagnostic 12.5 months; p< 0.0001) and significantly lower likelihood of all-cause mortality (HR 0.90, 95%CI 0.82-0.99), as compared to the diagnostic group.
Conclusions: Routine imaging among patients at risk for HCC is associated with earlier stage diagnoses and improved survival, as compared to patients who undergo imaging intermittently and for diagnosis. These findings demonstrate the impact of timely and consistent healthcare access and can guide targeted interventions for promoting surveillance among patients at risk of developing HCC.
Learning Objectives:
Upon completion, participants will be able to discuss the distribution of surveillance patterns among patients at risk for hepatocellular carcinoma in the SEER-Medicare population.
Upon completion, participants will be able to discuss the impact of surveillance frequency on early stage diagnosis in patients at risk for hepatocellular carcinoma in the SEER-Medicare population.
Upon completion, participants will be able to discuss the survival impact of routine surveillance in patients at risk for hepatocellular carcinoma in the SEER-Medicare population.
