Adherence to hepatocellular carcinoma screening in cirrhotic patients and efficiency of diagnostic methods

Adherence to Hepatocellular Carcinoma Screening in Cirrhotic Patients and Efficiency of Diagnostic Methods Background and Aim: Current guidelines recommend screening cirrhosis patients every 6 months for the development of HCC with imaging methods and/or biomarkers. In our study, it was aimed to determine whether HCC screening in cirrhotic patients is performed with appropriate methods and at appropriate time intervals and to evaluate the results of the screening. Materials and Methods: The research is a retrospective cohort study. Patients over the age of 18, diagnosed with Child-Pugh class A or B cirrhosis, who were admitted to the Karadeniz Technical University Faculty of Medicine Gastroenterology Polyclinic between 2010 and 2020 and/or were hospitalized in the gastroenterology service were included in our study. Patients with another non-HCC malignancy and Child-Pugh class C cirrhotic patients were excluded from the study. Demographic and clinical characteristics of patients were recorded from hospital records and patient files. It was determined from hospital records whether these patients were followed up at appropriate intervals for HCC. For this purpose, the patients were divided into 2 groups as followed up (those who underwent imaging and/or AFP with USG, CT or MR at 4-8-month intervals) and those who were not followed up (those who underwent insufficient screening and those who were not scanned). These groups were compared in terms of HCC development, curative treatment and survival. Results: A total of 641 cirrhosis patients who met the inclusion criteria were included in the study. Of the patients, 363 (56.6%) were male and 278 (43.4%) were female with a mean age at diagnosis of 61.12±13.3 years. Only 146 (22.7%) patients were screened for HCC according to guidelines. A total of 89 patients were diagnosed with HCC during the follow-up period (42 (28.8%) patients in the follow-up group and 47 (9.5%) patients in the non-follow-up group, p<0.001). The rate of early stage HCC detection (83.3% vs. 40.4%), curative treatment (78.4% vs. 33.3%) and median survival (74 vs. 21.7 months) were higher in the follow-up group (p<0.001). Conclusion: HCC screening rates are very low in cirrhotic patients. In these patients, HCC screening in accordance with the guidelines results in an earlier diagnosis, which increases both curative treatment and overall survival. Keywords: Surveillance, Screening, Hepatocellular cancer, Cirrhosis