Current Surveillance Strategy Is Less Effective for Detecting Early-Stage Hepatocellular Carcinoma in Patients with Non-Viral and Non-Cirrhotic Liver Disease

Spiers, Jessica; Li, Wenhao; Aravinthan, Aloysious D.; Bannaga, Ayman; Caddick, Katharine; Culver, Emma L.; Faulkes, Rosemary E.; Gordon, Victoria; Hussain, Yaqza; Miller, Hamish; Merry, Jenny; Saad, Muhammad; Sheth, Abhishek; Shah, Tahir; Shetty, Shishir; Srivastava, Ankur; Subhani, Mohsan; Tahir, Muhammad Nauman; Than, Nwe Ni; Unitt, Esther; Alazawi, William

Abstract

Introduction
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths. Current international guidelines recommend 6-monthly ultrasound surveillance in all patients with cirrhosis and those with hepatitis B virus-related risk factors to detect early-stage HCC. However, it is unknown whether the benefits of surveillance are comparable across patient groups and underlying disease-related factors. We aimed to evaluate patient- and disease-related factors associated with HCC stage at diagnosis and survival in an ethnically diverse UK population.

Methods
This was a multicentre retrospective observational study including patients with newly-diagnosed HCC between 2007-2020 from six UK centres. Cox proportional-hazards regression and multivariate logistic regression models were used.

Results
1780 HCC patients comprising 20.9% with ArLD, 29.7% with NAFLD and 31.0% with viral hepatitis, were analysed. Surveillance was associated with improved survival in patients with viral hepatitis, but not in patients with ArLD and NAFLD. Surveillance was also associated with early-stage disease (BCLC stage 0 or A) at presentation in viral hepatitis, but not in patients with ArLD. Females with ArLD were 2.5-fold more likely to present with early-stage HCC than males. Patients with NAFLD were more likely to develop HCC in the absence of cirrhosis. Type 2 diabetes was not associated with mortality, but metformin use did show survival benefit. Patients of White ethnicity had improved survival and were less likely to present with late-stage HCC compared to other ethnicities.

Conclusion
HCC surveillance as currently delivered was less effective for detecting early-stage HCC in patients with non-viral and non-cirrhotic liver disease. Gender and ethnicity influences stage at presentation and outcomes. HCC surveillance strategies are needed to refine risk stratification particularly in patients with NAFLD or without cirrhosis.

Citation

Spiers, J., Li, W., Aravinthan, A. D., Bannaga, A., Caddick, K., Culver, E. L., Faulkes, R. E., Gordon, V., Hussain, Y., Miller, H., Merry, J., Saad, M., Sheth, A., Shah, T., Shetty, S., Srivastava, A., Subhani, M., Tahir, M. N., Than, N. N., Unitt, E., & Alazawi, W. (2025). Current Surveillance Strategy Is Less Effective for Detecting Early-Stage Hepatocellular Carcinoma in Patients with Non-Viral and Non-Cirrhotic Liver Disease. Liver Cancer, https://doi.org/10.1159/000542805

• Journal Article Type: Article
• Acceptance Date: Nov 21, 2024
• Online Publication Date: Mar 26, 2025
• Publication Date: Mar 26, 2025
• Deposit Date: Apr 21, 2025
• Publicly Available Date: Apr 22, 2025
• Print ISSN: 2235-1795
• Electronic ISSN: 1664-5553
• Publisher: Karger Publishers
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1159/000542805
• Public URL: https://nottingham-repository.worktribe.com/output/48088852
• Publisher URL: https://karger.com/lic/article/doi/10.1159/000542805/924424/Current-surveillance-strategy-is-less-effective