A retrospective, multicenter cohort study, published in JAMA Network Open, found that hepatocellular carcinoma (HCC) surveillance was underutilized among approximately 80% of patients with cirrhosis.

HCC is the third leading cause of cancer-related deaths worldwide and patients with cirrhosis are at increased risk for poorer prognosis. In order to evaluate the effectiveness of HCC screening in the cirrhosis setting, researchers evaluated HCC surveillance rates in the 36 months prior to HCC diagnosis among 629 patients with cirrhosis cared for at 5 centers in the United States. Survival outcomes were related with surveillance completion.

The patients were aged median 63.6 years at diagnosis, 78.1% were men, 54.1% were White, 51.0% had viremic hepatitis C virus liver disease, 61.8% had Class A Child-Pugh Classification, 54.2% had Stage A HCC, and 84.6% had known cirrhosis prior to HCC.

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Prior to HCC, 14.0% of patients received semiannual surveillance and 22.3% received annual surveillance. The most common surveillance modality was ultrasonography (60.9%), followed by contrast magnetic resonance imaging (21.6%) and contrast computed tomography (17.3%).

Patients with unrecognized cirrhosis (odds ratio [OR], 0.14; P =.007) and who were Black (OR, 0.41; P =.01) were less likely to receive semiannual surveillance, while patients with hepatitis B virus infection were more likely (OR, 3.06; P =.01) to receive semiannual surveillance.

Semiannual surveillance was associated with curative-intent therapy (OR, 2.73; P <.001) and annual surveillance was associated with curative-intent therapy (OR, 0.62; P =.08). Semiannual and annual surveillance strategies were not related to overall survival (P =.26 and P =.89, respectively).

This study was limited as the investigators were unable to ascertain whether surveillance was underused by clinicians or was a result of patient noncompliance. However, these data indicated that HCC surveillance remains largely underutilized among patients with cirrhosis.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Parikh ND, Tayob B, Al-Jarrah T, et al. Barriers to surveillance for hepatocellular carcinoma in a multicenter cohort. JAMA Netw Open. 2022;5:e2223504. doi:10.1001/jamanetworkopen.2022.23504