Surveillance of hepatocellular carcinoma in Slovakia

Background: Certain trials have demonstrated that surveillance of hepatocellular carcinoma (HCC) lowers mortality via earlier dia­gnosis and therapy. We aimed to analyse surveillance performance in order to define targets for improvement. Methods: We retrospectively analysed consecutive patients (pts) ELIGIBLE for surveillance between January 2001 and December 2010, with three questions: 1. How many have had surveillance RECOMMENDED and 2. PERFORMED, and by which method and 3. with what outcome. We divided the pts into three groups by dia­gnosis of cirrhosis or HBV infection (ELIGIBLE), written recommendation for surveillance (RECOMMENDED) and ≥ 2 US or alpha-fetoprotein (AFP) exams six months apart (PERFORMED). We recorded the demographics, liver disease characteristics, ultrasound (US), AFP, new lesions, their size and mortality. We excluded patients without data for analysis. Results: We identified 445 and excluded 52 of the ELIGIBLE pts. The remaining 393 pts formed the RECOMMENDED group: 334 (85%) with cirrhosis, 59 (15%) with HBV infection. The median age was 55 years, 34% were females. The most prevalent aetiologies were alcohol-related liver disease (ALD, 46%), non-alcoholic steatohepatitis (NASH, 17%) and hepatitis C virus (HCV, 12%). Surveillance was PERFORMED in 322 (82%) of the RECOMMENDED pts by US only in 1%, AFP in 40% and US with AFP in 31% of the pts, respectively. New lesions were detected in 2.2% of the pts, aged 63.5 years (53–79), with diameter of 31.5 mm (9–120) in 8 surveillance pts and 75 mm (35–115) in 2 pts without surveillance (p = 0.296). Conclusion: This quality control study has shown that the uptake of HCC surveillance in pts with valid indication was suboptimal, the methods used deviated considerably from the guidelines and the diameter of newly-detected lesions was larger than would be required for surveillance to be effective.