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Screening is associated with a lower risk of hepatocellular carcinoma-related mortality in patients with chronic hepatitis B
Feng Su
Noel S. Weiss
Lauren A. Beste
Pamela Green
Kristin Berry
George N. Ioannou
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Published:November 24, 2020DOI:https://doi.org/10.1016/j.jhep.2020.11.023
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HIGHLIGHTS
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We used a case-control paradigm to investigate HCC screening effectiveness in HBV-infected patients
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We identified 169 cases who died of HCC, matched to 169 controls who did not die of HCC
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HCC screening by ultrasound and/or serum AFP was associated with a significant reduction in HCC-related mortality
ABSTRACT
Background and Aims
Patients with chronic hepatitis B (CHB) infection routinely undergo screening for hepatocellular carcinoma (HCC), but the efficacy of screening remains unclear. We aimed to evaluate the impact of screening with ultrasound (USS) and/or serum alpha-fetoprotein (AFP) on HCC-related mortality in patients with CHB.
Methods
We performed a matched case-control study of patients with CHB receiving care through the Veterans Affairs (VA) health administration. Cases were patients who died of HCC between 01/01/2004 and 12/31/2017, while controls were patients with CHB who did not die of HCC. Cases were matched to controls by CHB diagnosis date, age, sex, race/ethnicity, cirrhosis, antiviral therapy exposure, hepatitis B e antigen status, and viral load. We identified screening USS and AFPs obtained in the 4 years preceding HCC diagnosis in cases and the equivalent index date in controls. Using conditional logistic regression, we compared cases and controls with respect to receipt of screening. A lower likelihood of screening in cases corresponds to an association between screening and reduced risk of HCC-related mortality.
Results
We identified 169 cases, matched to 169 controls. Fewer cases than controls underwent screening with either screening modality (33.7% versus 58.6%) or both modalities (19.5% versus 34.4%). In multivariable conditional logistic regression, screening with either modality was associated with a lower risk of HCC-related mortality (adjusted odds ratio [aOR] 0.21, 95% confidence interval [CI] 0.09-0.50), as was screening with both modalities (aOR of 0.13, 95% CI 0.04-0.43).
Conclusions
HCC screening was associated with a substantial reduction in HCC-related mortality in VA patients with CHB.
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