Surveillance as Determinant of Long-Term Survival in Non-Transplanted Hepatocellular Carcinoma Patients

SIMPLE SUMMARY: Some patients with hepatocellular carcinoma (HCC) obtain a very long survival, irrespective of any prediction. In this study, we looked for the impact of surveillance in long-term survival of HCC patients. After adjustment for confounders in multivariable logistic regression analysis, diagnosis under surveillance remained an independent predictor of long-term survival. In the surveillance group, observed and lead-time corrected survivals were significantly longer than in patients with casual/symptomatic diagnosis. However, when adjusted for baseline characteristics with inverse probability weights, surveillance and no surveillance groups demonstrated a similar survival, suggesting that the beneficial effect of surveillance is mediated by early stage diagnosis, which allows higher applicability of curative treatments. Surveillance is a major determinant of long-term survival and a wide implementation of surveillance programs should be pursued in order to improve the still poor prognosis of HCC patients. ABSTRACT: Purpose: We aimed at assessing the impact of surveillance on long-term survival in HCC patients. Methods: From the ITA.LI.CA database, we selected 1028 cases with long (≥5 years, LS group) and 2721 controls with short-term survival (<5 years, SS group). The association between surveillance and LS was adjusted for confounders by multivariable logistic regression analysis. Survival of surveilled patients was presented both as observed and corrected for the lead-time bias, and the comparison of survival between surveillance and no surveillance groups was also performed after balancing the baseline characteristics with inverse probability weights (IPW). Results: LS patients were more frequently diagnosed under surveillance (p < 0.0001), and had more favorable baseline characteristics. Surveillance was an independent predictor of LS (OR = 1.413, 95% CI 1.195–1.671; p < 0.0001). The observed and the lead-time corrected survival of surveilled patients were significantly longer compared to the survival of not surveilled patients (p < 0.0001 and p = 0.0008, respectively). In IPW adjusted populations, no survival differences were demonstrated between the two groups (p = 0.30). Conclusions: Surveillance, increasing early-stage diagnosis and applicability of curative treatments, is a fundamental determinant of long-term survival in HCC patients. A wide implementation of surveillance programs should be pursued in order to improve HCC patients’ prognosis.