Highlights
- •We used a case-control paradigm to investigate HCC screening effectiveness in HBV-infected patients.
- •We identified 169 cases who died of HCC, matched to 169 controls who did not die of HCC.
- •HCC screening by ultrasound and/or serum AFP was associated with a significant reduction in HCC-related mortality.
Background & 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 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 ultrasound 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% vs. 58.6%) or both modalities (19.5% vs. 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% 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.
Lay summary
Patients with hepatitis B infection have a high risk of developing liver cancer. It
is therefore recommended that they undergo frequent screening for liver cancer, but
whether this leads to a lower risk of dying from liver cancer is not clear. In this
study, we show that liver cancer screening is associated with a reduction in the mortality
from liver cancer in patients with hepatitis B infection.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: November 24, 2020
Accepted:
November 16,
2020
Received in revised form:
November 6,
2020
Received:
January 5,
2020
Identification
Copyright
© 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
