Association between ultrasonography screening and mortality in patients with hepatocellular carcinoma: a nationwide cohort study
- 1Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
- 2Faculty of Medicine and Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- 3Department of Public Health and Graduate Institute of Clinical Medical Sciences, China Medical University, Taichung, Taiwan
- 4National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
- 5Department of Life Sciences and Rong Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan
- 6Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan
- 7School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- 8Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Correspondence to Professor Chun-Ying Wu, Division of Gastroenterology, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Avenue, Taichung 407, Taiwan;
- Received 10 November 2014
- Revised 17 January 2015
- Accepted 19 January 2015
- Published Online First 10 February 2015
Objective Current guidelines recommend screening for hepatocellular carcinoma (HCC) in high-risk populations. However, the effectiveness of screening in reducing mortality has been challenged. In addition, it is unclear which subgroups benefit most from HCC screening.
Design This nationwide cohort study identified a total of 52 823 newly diagnosed HCC patients between 1 January 2002 and 31 December 2007. These HCC patients were classified into the following cohorts according to the time intervals in which they received ultrasonography screening: 0–6 months (6M), 7–12 months (12M), 13–24 months (24M), 25–36 months (36M) and not screened within 3 years (never screened). The chance to receive curative therapy and 5-year cumulative mortalities were calculated after adjusting for lead-time bias.
Results Chances to receive curative therapy among the 6M, 12M, 24M, 36M and never screened cohorts were 24.3% (95% CI 23.7% to –24.9%), 26.9% (95% CI 25.7% to 28.2%), 22.9% (95% CI 21.8% to 24.1%), 21.3% (95% CI 19.9% to 22.8%) and 18.3% (95% CI 17.8% to 18.8%), respectively. Compared with the 6M cohort, adjusted HRs of mortality for the 12M, 24M, 36M and never screened cohorts were 1.11 (95% CI 1.07 to 1.15), 1.23 (95% CI 1.19 to 1.28), 1.31 (95% CI 1.26 to 1.37) and 1.47 (95% CI 1.43 to 1.51) (all p<0.001), respectively. On multivariable subgroup analyses, the associations between shorter screening intervals and better survival were observed in nearly all subgroups, especially in younger patients, patients without diabetes and patients with hepatitis B infection.
Conclusions Shorter ultrasonography screening intervals are associated with reduced overall mortality in HCC patients in a dose-dependent manner.