Impact of nationwide hepatocellular carcinoma surveillance on the prognosis in patients with chronic liver disease
Won Sohn 1 , Danbee Kang 2 3 , Minwoong Kang 3 4 5 , Eliseo Guallar 2 3 6 , Juhee Cho 2 3 4 , Yong-Han Paik 2 4 7 8
Affiliations
Affiliations
1
Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
2
Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sunkyunkwan University, Seoul, Korea.
3
Center for Clinical Epidemiology, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.
4
Department of Digital Healthcare, Samsung Advanced Institute for Health Science and Technology, Sunkyunkwan University, Seoul, Korea.
5
Division of Population Health Research, Department of Precision Medicine, Korea National Institute of Health, Cheongju, Korea.
6
Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins School of Public Health, Baltimore, MD, USA.
7
Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
8
Department of Health Science and Technology, Samsung Advanced Institute for Health Science and Technology, Sunkyunkwan University, Seoul, Korea.
PMID: 36263667 DOI: 10.3350/cmh.2022.0037
Abstract
Background/aims: This study aimed to investigate the effect of hepatocellular carcinoma (HCC) surveillance using the Korea National Liver Cancer Screening Program on the receipt of curative treatment for HCC and mortality in patients with chronic liver disease.
Methods: This population-based cohort study from the Korean National Health Insurance Service included 2003 to 2015 claims data collected from 1,209,825 patients aged ≥40 years with chronic hepatitis B, chronic hepatitis C, and liver cirrhosis. Patients were divided according to HCC surveillance using ultrasonography and serum alpha-fetoprotein every 6-12 months. The study outcomes were the receipt of curative treatment (surgical resection, radiofrequency ablation, or liver transplantation) and all-cause mortality.
Results: The study population consisted of 1,209,825 patients with chronic hepatitis B, chronic hepatitis C, and liver cirrhosis (median age, 52.0 years; interquartile range, 46-55 years; 683,902 men [56.5%]). The proportion of participants who underwent HCC surveillance was 52.7% (n=657,889). During 10,522,940 person-years of follow-up, 74,433 HCC cases developed, including 36,006 patients who underwent curative treatment. The surveillance group had a significantly higher proportion of curative treatment for HCC than the non-surveillance group after adjusting for confounding factors (adjusted hazard ratio [HR], 5.64; 95% confidence interval [CI], 5.48-5.81). The surveillance group had a significantly lower mortality rate than the non-surveillance group (adjusted HR, 0.56; 95% CI, 0.55-0.56).
Conclusion: HCC surveillance using the national screening program in patients with chronic viral hepatitis or liver cirrhosis provides better opportunity for curative treatment for HCC and improves overall survival.
Keywords: Hepatitis; Hepatocellular carcinoma; Liver cirrhosis; Nationwide healthcare insurance; Public health surveillance. 作者: StephenW 时间: 2022-10-20 21:57