Shorter intervals of ultrasound screening helps in early detection of liver cancer: JAMA
Taiwan: Ultrasound screening using shorter intervals (less than 6 to 12 months) is associated with early detection of hepatocellular carcinoma (HCC) in hoigh-risk patients, suggests a recent study. This would help in saving more lives and improve quality of life.
The findings of the study are published in JAMA Network Open.
Hepatocellular carcinoma accounts for most cases of liver cancer. Despite advances in medical technology and treatment on recent years, the 5-year survival rate of HCC remains low. Despite recommendations from international guidelines, there are different clinical practices regarding ultrasonography screening intervals for HCC.
Against the above background, Shih-Chiang Kuo, National Cheng Kung University, Tainan, Taiwan, and colleagues aimed to evaluate whether ultrasonography screening using intervals suggested by international guidelines is associated with cancer stage shifting, reductions in mortality, and improved quality of life (QoL) for patients with HCC in this nationwide comparative effectiveness research study.
For this purpose, the researchers estimated lifetime survival functions using interlinkages of 3 databases from Taiwan combined with QoL measurements obtained from National Cheng Kung University Hospital. In total, 114 022 patients listed as having newly diagnosed HCC from 2002 through 2015 and were followed up until 2017. The researchers prospectively measured QoL values of 1059 patients with HCC who visited National Cheng Kung University Hospital with the European QoL-5 dimensions questionnaire from 2011 through 2019.
Patients were categorized based on the time between their last ultrasonography screening and the index date (90 days prior to HCC diagnosis) as 1 of 5 subcohorts: 6 months (0-6 months), 12 months (7-12 months), 24 months (13-24 months), 36 months (25-36 months), and longer than 36 months (no screening in the previous 3 years). Data were analyzed from April 2020 to April 2021.
There were 59 194 patients with Barcelona Clinic Liver Cancer staging information, including 42 081 men (mean age, 62.2 years) and 17 113 women (mean age, 69.0 years).
Key findings of the study include:
- There was a consistent trend showing that the longer the interval between ultrasonography examinations, the higher the loss of life expectancy and loss of quality-adjusted life expectancy for both sexes.
- Loss of quality-adjusted life expectancy values for male subcohorts were 10.0 quality-adjusted life-years (QALYs) for ultrasonography screening intervals of 6 months, 11.1 QALYs for 12 months, 12.1 QALYs for 24 months, 13.1 QALYs for 36 months, and 14.6 QALYs for longer than 36 months.
- Loss of quality-adjusted life expectancy values for female subcohorts were 9.0 QALYs for 6 months, 9.7 QALYs for 12 months, 10.3 QALYs for 24 months, 10.7 QALYs for 36 months, and 11.4 QALYs for longer than 36 months.
- Patients with underlying hepatitis B virus infection or cirrhosis had the greatest improvement in life expectancy with shorter screening intervals.
"The results of this study suggest that regular ultrasonography screening with an interval of 6 to 12 months or less may lead to early detection of HCC and may save lives and improve utility for patients with HCC from a lifetime perspective," wrote the authors.
"Because people with underlying risk factors (including hepatitis B virus or hepatitis C virus infection, cirrhosis, and alcoholic liver disease) showed only slightly more frequent ultrasonography screening than those without underlying risk factors, we recommend improving this clinical practice," concluded the authors.
Reference:
The study titled, "Optimal Intervals of Ultrasonography Screening for Early Diagnosis of Hepatocellular Carcinoma in Taiwan," is published in JAMA Network Open.
DOI: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781318
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