Survival of hepatocellular carcinoma patients may be improved in surveillance interval not more than 6 months compared with more than 6 months: A 15-year prospective study

GOALS:: To compare hepatocellular carcinoma (HCC) stage, treatment modality, and survival between groups submitted to different surveillance interval. BACKGROUND:: It is not clear if surveillance interval affects patient survival with HCC. STUDY:: Clinical data from 10,307 patients at risk for HCC were prospectively collected from 1990 to 2005. The characteristics of cancer and 5-year survival in patients diagnosed as HCC during follow-up were compared between surveillance interval of <6 months and beyond 6 months. RESULTS:: A total of 400 patients were diagnosed with HCC, with a mean tumor size of 3.5 cm and an annual detection rate of 2.4%. The tumor sizes detected in patients with surveillance interval ≤6 months were significantly smaller than those detected in patients with interval of >6 months (n=219; 3.0±1.7 cm vs. n=181; 4.0±2.6 cm, P<0.001). The survival benefit in patients with surveillance interval of ≤6 months was significant compared with those with interval of >6 months even after considering lead time with assumed tumor doubling time of 60 days. The 5-year survival of HCC patients surveyed between 2000 and 2004 was significantly higher compared with those surveyed between 1990 and 1994 or between 1995 and 1999 (41% vs. 17% and 19%, respectively, P<0.0001). Using a Cox regression model, Child-Pugh class, Japanese tumor-node-metastasis stage, and α-fetoprotein levels were independently associated with patient survival. CONCLUSIONS:: Our data show that surveillance ≤6 months might be associated with early detection of HCC and improved survival in a hepatitis B endemic area.