The surveillance for hepatocellular carcinoma, it’s fine. To diagnose the cirrhosis, it’s better.

Lepour, Maxence [UCL] de Terwangne, Christophe [UCL] Henrion, Jean Descamps, Olivier de Vos, Marie

Background Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third cause of cancer death. Cirrhosis is a major risk factor for HCC in the Western world. International recommendations suggest screening cirrhotic patients twice a year for HCC. This surveillance is associated with early tumor detection, possibility of curative treatment and aims to improve survival. In real life, fewer than one-third of cirrhotic patients undergo screening for HCC in western countries and many patients do not enter into surveillance programs due to undiagnosed cirrhosis. Therefore, the efficacy of this surveillance on mortality is debated. Aims We first aimed to assess the quality of surveillance in patients diagnosed with HCC in a background of cirrhosis. We secondly assessed the efficiency of this surveillance in terms of prognosis of HCC (earlier stage of cancer extension and accessibility to curative treatment). Methods In this retrospective single center study, we identified patients with HCC from January 2017 to December 2021 by reviewing reports of multidisciplinary digestive-oncology consultations. We excluded patients without cirrhosis, recurrent diagnosis of HCC and mixed tumors. We classified the surveillance before the diagnosis of HCC as 3 groups: A) recommended surveillance (patients with known cirrhosis and at least one imaging during the year before diagnosis), B) inconsistent surveillance (patients with known cirrhosis but no imaging during the year before diagnosis) and C) concomitant diagnosis of cirrhosis and HCC. HCC extension (based on the Barcelona Clinic Liver Cancer [BCLC] score) and initial treatment provided were reviewed and compared between group A and groups B + C. Results One hundred thirty-six patients were identified with a diagnosis of HCC. We excluded 25 non-cirrhotic patients, 15 recurrences, 3 unclear diagnoses. On the 95 selected patients, 36 (38%) had a recommended surveillance (group A), 17 (18%) had an inconsistent surveillance (group B) and 42 (44%) had a concomitant diagnosis of cirrhosis and HCC (group C). From the 53 patients with known cirrhosis, 36 (68%) were correctly screened whereas 17 patients did not follow the surveillance program. In this last group, 15 (88%) of them were clearly informed about the utility of the surveillance for HCC. In group A, 29 patients (80%) had an early-stage disease (BCLC stage 0 or A) and 24 (67%) were eligible for curative treatment (surgery or thermo-ablation). Amongst the patients not correctly screened (from groups B + C), only 18 (30%) had an early-stage disease and 13 (23%) were eligible for a curative treatment. Conclusion Amongst the patients with HCC on cirrhosis, almost half of them were diagnosed for the HCC concomitantly with their cirrhosis. For the other patients, with previously known cirrhosis, two-third were correctly followed-up according to current recommendations. Regular surveillance in cirrhotic patients was associated with an earlier stage diagnosis of HCC and a better access to curative treatment. We underline the importance to diagnose the pre-existing cirrhosis to implement a correct surveillance program for HCC. Tools like APRI, Fib4-score and fibroscan may help to screen high-risk groups for chronic liver disease in primary care.