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- Title
Screening for Hepatocellular Carcinoma in Chronic Liver Disease.
- Authors
Kansagara, Devan; Papak, Joel; Pasha, Amirala S.; O’Neil, Maya; Freeman, Michele; Relevo, Rose; Ana Quiñones, Ana; Motu’apuaka, Makalapua; Jou, Janice H.
- Abstract
Background: Guidelines recommend routine screening for hepatocellular carcinoma (HCC) in high-risk patients, but the strength of evidence supporting these recommendations is unclear. Purpose: To review the benefits and harms of HCC screening in patients with chronic liver disease. Data Sources: MEDLINE, PsycINFO, and ClinicalTrials.gov from inception to April 2014; Cochrane databases to June 2013; reference lists; and technical advisors. Study Selection: English-language trials and observational studies comparing screening versus no screening, studies of harms, and trials comparing different screening intervals. Data Extraction: Mortality and adverse events were the outcomes of interest. Individual-study quality and the overall strength of evidence were dual-reviewed using published criteria. Data Synthesis: Of 13 801 citations, 22 studies met inclusion criteria. The overall strength of evidence on the effects of screening was very low. One large trial of patients with hepatitis B found decreased HCC mortality with periodic ultrasonographic screening (rate ratio, 0.63 [95% CI, 0.41 to 0.98]), but the study was limited by methodological flaws. Another trial in patients with hepatitis B found no survival benefit with periodic α-fetoprotein screening. In 18 observational studies, screened patients had earlier-stage HCC than clinically diagnosed patients, but lead- and length-time biases confounded the effects on mortality. Two trials found no survival differences between shorter (3- to 4-month) and longer (6- to 12-month) screening intervals. Harms of screening were not well-studied. Limitations: Only English-language studies were included. The evidence base is limited by methodological issues and a paucity of trials. Conclusion: There is very-low-strength evidence about the effects of HCC screening on mortality in patients with chronic liver disease. Screening tests can identify early-stage HCC, but whether systematic screening leads to a survival advantage over clinical diagnosis is uncertain. Primary Funding Source: U.S. Department of Veterans Affairs Quality Enhancement Research Initiative.
- Subjects
LIVER cancer; LIVER cancer patients; EARLY detection of cancer; HEPATITIS B; CIRRHOSIS of the liver; CANCER-related mortality; UNITED States. Dept. of Veterans Affairs; PATIENTS
- Publication
Annals of Internal Medicine, 2014, Vol 161, Issue 4, p261
- ISSN
0003-4819
- Publication type
Article
- DOI
10.7326/M14-0558