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Use of hepatocellular carcinoma surveillance in patients with cirrhosis: a systematic review and meta-analysis
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BACKGROUND AND AIMS: Hepatocellular carcinoma (HCC) surveillance is associated with early tumor detection and improved survival; however, it is often underused in clinical practice. We aimed to characterize surveillance use among patients with cirrhosis and the efficacy of interventions to increase surveillance. APPROACH AND RESULTS: We performed a systematic literature review using the MEDLINE database from January 2010 through August 2018 to identify cohort studies evaluating HCC surveillance receipt or interventions to increase surveillance in patients with cirrhosis. A pooled estimate for surveillance receipt with 95% confidence intervals was calculated. Correlates of surveillance use were defined from each study and prespecified subgroup analyses. Twenty-nine studies, with a total of 118,799 patients, met inclusion criteria, with a pooled estimate for surveillance use of 24.0% (95% confidence interval, 18.4-30.1). In subgroup analyses, the highest surveillance receipt was reported in studies with patients enrolled from subspecialty gastroenterology/hepatology clinics and lowest in studies characterizing surveillance in population-based cohorts (73.7% versus 8.8%, P < 0.001). Commonly reported correlates of surveillance included higher receipt among patients followed by subspecialists and lower receipt among those with alcohol-associated or nonalcoholic steatohepatitis (NASH)-related cirrhosis. All eight studies (n = 5,229) evaluating interventions including patient/provider education, inreach (e.g., reminder and recall systems), and population health outreach strategies reported significant increases (range 9.4%-63.6%) in surveillance receipt. CONCLUSIONS: HCC surveillance remains underused in clinical practice, particularly among patients with alcohol-associated or NASH-related cirrhosis and those not followed in subspecialty gastroenterology clinics. Interventions such as provider education, inreach including reminder systems, and population health outreach efforts can significantly increase HCC surveillance.
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“Cirrhosis in MASLD is under-recognised compared to other aetiologies, 248 with less than one in four individuals with cirrhosis undergoing HCC surveillance. 249”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [249]
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Metadata
- Authors
- Wolf, E., Rich, N. E., Marrero, J. A., Parikh, N. D., & Singal, A. G.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- University of Michigan (US)
- Corresponding author
- Singal, Amit G.
- Venue
- Hepatology
- Published
- 2020-11-20
- Volume
- 73
- Issue
- 2
- Pages
- 713-725
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- PMC
- PMC7648722
- OpenAlex
- W3021721319
- Cited by
- 333
- References
- 56
- Citations by year
- 2026: 47 · 2025: 69 · 2024: 66 · 2023: 57 · 2022: 48 · 2021: 33 · 2020: 13
- FWCI
- 5.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- Funders
- National Institutes of Health
- National Cancer Institute (U01CA230694, U01CA230669)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
- Keywords
- HCC surveillance, liver cirrhosis, alcoholic cirrhosis, nonalcoholic steatohepatitis, provider education, early cancer detection
- MeSH terms
- Carcinoma, Hepatocellular, Humans, Liver Cirrhosis, Liver Neoplasms, Mass Screening, Patient Acceptance of Health Care, Practice Patterns, Physicians', Guideline Adherence, Early Detection of Cancer
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