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TOPLINE:

Hepatocellular carcinoma (HCC) screening in patients with cirrhosis or chronic hepatitis B virus (HBV) infection is associated with improved early-stage detection and survival benefits that persist after adjusting for lead-time and length-time biases, a new analysis showed.

METHODOLOGY:

• The efficacy of HCC screening in patients with cirrhosis is controversial due to a lack of randomized data and cohort studies' inherent biases: Lead-time bias, when screening leads to earlier cancer detection so survival duration seems longer, and length-time bias, an overestimation of survival because screening is more likely to detect slow-growing tumors.
• Researchers characterized the benefits of HCC screening after adjusting for lead-time and length-time biases in a cohort of 1313 patients with cirrhosis or HBV infection and newly diagnosed HCC at two large US health systems.
• The primary outcome was screen-detected HCC, defined as cancer found through imaging conducted for screening purposes or to monitor a liver lesion or alpha-fetoprotein tumor marker test within 6 months before diagnosis.

TAKEAWAY:

• HCC was screen-detected in 556 patients (42.3%) and nonscreen-detected in 757 (57.7%). Nonscreen detection was defined as incidental or symptomatic detection based on the presence of potential HCC-related symptoms.
• Patients with screen-detected HCC had higher rates of early-stage disease (70.7% vs 45.7%) and receipt of curative treatment (51.1% vs 33.5%) than peers with nonscreen-detected HCC.
• Screen-detected HCC was associated with significantly lower mortality, which persisted after correcting for lead-time bias.
• Adjustment for length-time bias decreased survival estimates, although 3- and 5-year survival remained longer with screen-detected HCC (37% and 26%, respectively) than nonscreen-detected HCC (25% and 8%, respectively).

IN PRACTICE:

"Understanding the true benefit of HCC screening is important for determining its overall value, considering potential physical, financial, and psychological harms," the authors wrote. "These findings suggest that HCC screening is associated with reduced mortality, even after accounting for lead-time and length-time biases, and remains an important target for interventions to increase utilization."

SOURCE:

The study, with first author Darine Daher, MD, University of Texas Southwestern Medical Center, Dallas, was published online in JAMA Network Open.

LIMITATIONS:

The study was retrospective and subject to potential ascertainment and misclassification biases and a risk for residual confounding. The findings may not be generalizable to broader populations outside the United States. Tumor growth patterns were derived from patients without interval treatment, which may have a higher proportion of indolent tumors, and tumor growth patterns within each patient may vary over time.

DISCLOSURES:

The researchers received support from the National Cancer Institute, Cancer Prevention & Research Institute of Texas, and Singapore Ministry of Health. Several authors disclosed consulting and advisory roles in and research funding from various pharmaceutical and healthcare companies.