HCC surveillance improves early detection, curative treatment receipt, and survival in patients with cirrhosis: A meta-analysis

医学 内科学 危险系数 荟萃分析 肝细胞癌 肝硬化 阶段(地层学) 置信区间 队列研究 随机对照试验 生物 古生物学
作者
Amit G. Singal,Emily Zhang,Manasa Narasimman,Nicole E. Rich,Akbar K. Waljee,Yujin Hoshida,Ju Dong Yang,María Reig,Giuseppe Cabibbo,Pierre Nahon,Neehar D. Parikh,Jorge A. Marrero
出处
期刊:Journal of Hepatology [Elsevier BV]
卷期号:77 (1): 128-139 被引量:187
标识
DOI:10.1016/j.jhep.2022.01.023
摘要

•HCC surveillance was associated with improved early-stage detection, curative treatment receipt, and prolonged survival.•Semi-annual surveillance intervals were associated with improved early HCC detection and overall survival.•Few studies evaluated surveillance outcomes in post-SVR or NAFLD patient populations; thus, future research is warranted.•Few studies characterized surveillance-related harms, although available data suggest surveillance harms are mild in severity. Background & AimsThere is controversy regarding the overall value of hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis given the lack of data from randomized-controlled trials. To address this issue, we conducted a systematic review and meta-analysis of cohort studies evaluating the benefits and harms of HCC surveillance in patients with cirrhosis.MethodsWe performed a search of the Medline and EMBASE databases and national meeting abstracts from January 2014 through July 2020 for studies reporting early-stage HCC detection, curative treatment receipt, or overall survival, stratified by HCC surveillance status, among patients with cirrhosis. Pooled risk ratios (RRs) and hazard ratios, according to HCC surveillance status, were calculated for each outcome using the DerSimonian and Laird method for random effects models.ResultsWe identified 59 studies including 145,396 patients with HCC, which was detected by surveillance in 41,052 (28.2%) cases. HCC surveillance was associated with improved early-stage detection (RR 1.86, 95% CI 1.73–1.98; I2 = 82%), curative treatment receipt (RR 1.83, 95% CI 1.69–1.97; I2 = 75%), and overall survival (hazard ratio 0.67, 95% CI 0.61–0.72; I2 = 78%) after adjusting for lead-time bias; however, there was notable heterogeneity in all pooled estimates. Four studies examined surveillance-related physical harms due to false positive or indeterminate surveillance results, but no studies examined potential financial or psychological harms. The proportion of patients experiencing surveillance-related physical harms ranged from 8.8% to 27.5% across studies, although most harms were mild in severity.ConclusionHCC surveillance is associated with improved early detection, curative treatment receipt, and survival in patients with cirrhosis, although there was heterogeneity in pooled estimates. Available data suggest HCC surveillance is of high value in patients with cirrhosis, although continued rigorous studies evaluating benefits and harms are still needed.Lay summaryThere has been ongoing debate about the overall value of hepatocellular carcinoma (HCC) screening in patients with cirrhosis given the lack of data from randomized-controlled trials. In a systematic review of contemporary cohort studies, we found that HCC screening is associated with improved early detection, curative treatment receipt, and survival in patients with cirrhosis, although there were fewer data quantifying potential screening-related harms. Available data suggest HCC screening is of high value in patients with cirrhosis, although continued studies evaluating benefits and harms are still needed. There is controversy regarding the overall value of hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis given the lack of data from randomized-controlled trials. To address this issue, we conducted a systematic review and meta-analysis of cohort studies evaluating the benefits and harms of HCC surveillance in patients with cirrhosis. We performed a search of the Medline and EMBASE databases and national meeting abstracts from January 2014 through July 2020 for studies reporting early-stage HCC detection, curative treatment receipt, or overall survival, stratified by HCC surveillance status, among patients with cirrhosis. Pooled risk ratios (RRs) and hazard ratios, according to HCC surveillance status, were calculated for each outcome using the DerSimonian and Laird method for random effects models. We identified 59 studies including 145,396 patients with HCC, which was detected by surveillance in 41,052 (28.2%) cases. HCC surveillance was associated with improved early-stage detection (RR 1.86, 95% CI 1.73–1.98; I2 = 82%), curative treatment receipt (RR 1.83, 95% CI 1.69–1.97; I2 = 75%), and overall survival (hazard ratio 0.67, 95% CI 0.61–0.72; I2 = 78%) after adjusting for lead-time bias; however, there was notable heterogeneity in all pooled estimates. Four studies examined surveillance-related physical harms due to false positive or indeterminate surveillance results, but no studies examined potential financial or psychological harms. The proportion of patients experiencing surveillance-related physical harms ranged from 8.8% to 27.5% across studies, although most harms were mild in severity. HCC surveillance is associated with improved early detection, curative treatment receipt, and survival in patients with cirrhosis, although there was heterogeneity in pooled estimates. Available data suggest HCC surveillance is of high value in patients with cirrhosis, although continued rigorous studies evaluating benefits and harms are still needed.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
酒玖柒完成签到 ,获得积分10
刚刚
刚刚
称心嫣娆发布了新的文献求助10
1秒前
Owen应助zyf采纳,获得10
1秒前
2秒前
顾矜应助插秧露娜采纳,获得10
2秒前
3秒前
陈强强完成签到,获得积分10
4秒前
Tsuns完成签到 ,获得积分10
5秒前
大喵发布了新的文献求助10
6秒前
啦啦啦完成签到,获得积分10
7秒前
7秒前
8秒前
8秒前
10秒前
11秒前
Mano完成签到,获得积分10
12秒前
小熊饼干发布了新的文献求助10
12秒前
12秒前
奇拉维特完成签到 ,获得积分10
12秒前
zyf发布了新的文献求助10
13秒前
13秒前
14秒前
闪闪如南完成签到,获得积分10
15秒前
15秒前
插秧露娜发布了新的文献求助10
16秒前
Steven发布了新的文献求助10
18秒前
称心嫣娆完成签到,获得积分10
19秒前
漂亮白枫发布了新的文献求助10
20秒前
peanut发布了新的文献求助10
23秒前
一直向前发布了新的文献求助10
24秒前
liziqi完成签到,获得积分10
28秒前
烟花应助漂亮白枫采纳,获得10
31秒前
天才幸运鱼完成签到,获得积分10
31秒前
泡泡应助公冶笑白采纳,获得10
32秒前
华仔应助公冶笑白采纳,获得10
32秒前
恋雅颖月应助公冶笑白采纳,获得10
32秒前
莉莉娅发布了新的文献求助10
32秒前
34秒前
36秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3989797
求助须知:如何正确求助?哪些是违规求助? 3531910
关于积分的说明 11255394
捐赠科研通 3270563
什么是DOI,文献DOI怎么找? 1805008
邀请新用户注册赠送积分活动 882157
科研通“疑难数据库(出版商)”最低求助积分说明 809190