Effectiveness of Hepatocellular Carcinoma Surveillance and an Optimal Surveillance Interval: Nationwide Cohort of Korea
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Purpose: To assess associations between surveillance intervals in a national hepatocellular carcinoma (HCC) surveillance programand receiving curative treatment and mortality using nationwide cohort data for Korea. Materials and Methods: Using the National Health Insurance Service Database of Korea, we retrospectively identified 3201852 patients,the target population of the national HCC surveillance program, between 2008 and 2017. After exclusion, a total of 64674 HCCpatients were divided based on surveillance intervals: never screened, ≤6 months (6M), 7–12 months (1Y), 13–24 months (2Y),and 25–36 months (3Y). Associations for surveillance interval with the chance to receive curative therapy and all-cause mortalitywere analyzed. Results: The 6M group (51.9%) received curative therapy more often than the other groups (1Y, 48.3%; 2Y, 43.8%; 3Y, 41.3%; neverscreened, 34.5%). Odds ratio for receiving curative therapy among the other surveillance interval groups (1Y, 0.87; 2Y, 0.76; 3Y, 0.77;never screened, 0.57; p<0.001) were significantly lower than that of the 6M group. The hazard ratios (HRs) of all-cause mortalitywere 1.07, 1.14, and 1.37 for 2Y, 3Y, and never screened groups. The HR for the 1Y group (0.96; p=0.092) was not significantly different,and it was lower (0.91; p<0.001) than that of the 6M group after adjustment for lead-time bias. Curative therapy was associatedwith survival benefits (HR, 0.26; p<0.001). Conclusion: HCC surveillance, especially at a surveillance interval of 6 months, increases the chance to receive curative therapy.
Abstract
Purpose: To assess associations between surveillance intervals in a national hepatocellular carcinoma (HCC) surveillance programand receiving curative treatment and mortality using nationwide cohort data for Korea. Materials and Methods: Using the National Health Insurance Service Database of Korea, we retrospectively identified 3201852 patients,the target population of the national HCC surveillance program, between 2008 and 2017. After exclusion, a total of 64674 HCCpatients were divided based on surveillance intervals: never screened, ≤6 months (6M), 7–12 months (1Y), 13–24 months (2Y),and 25–36 months (3Y). Associations for surveillance interval with the chance to receive curative therapy and all-cause mortalitywere analyzed. Results: The 6M group (51.9%) received curative therapy more often than the other groups (1Y, 48.3%; 2Y, 43.8%; 3Y, 41.3%; neverscreened, 34.5%). Odds ratio for receiving curative therapy among the other surveillance interval groups (1Y, 0.87; 2Y, 0.76; 3Y, 0.77;never screened, 0.57; p<0.001) were significantly lower than that of the 6M group. The hazard ratios (HRs) of all-cause mortalitywere 1.07, 1.14, and 1.37 for 2Y, 3Y, and never screened groups. The HR for the 1Y group (0.96; p=0.092) was not significantly different,and it was lower (0.91; p<0.001) than that of the 6M group after adjustment for lead-time bias. Curative therapy was associatedwith survival benefits (HR, 0.26; p<0.001). Conclusion: HCC surveillance, especially at a surveillance interval of 6 months, increases the chance to receive curative therapy.
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