Comparable Overall Survival in Patients with Hepatocellular Carcinoma Diagnosed within and outside a Surveillance Programme: The Potential Impact of Liver Cirrhosis

SIMPLE SUMMARY: Screening for liver cancer (hepatocellular carcinoma, HCC) is recommended for people with liver cirrhosis and some people with chronic liver disease. This study compares outcomes between patients diagnosed with HCC through surveillance and patients not included in surveillance. Patients diagnosed with HCC through surveillance had smaller tumours and an earlier cancer stage, but also had a higher incidence of cirrhosis. Although treatment rates were similar between the two groups, there was no difference in survival. This highlights the impact that liver cirrhosis has on tumour behaviour in HCC. ABSTRACT: Hepatocellular carcinoma (HCC) is the third leading cause of cancer death, and its incidence is rising. Mortality from HCC is predicted to increase by 140% by 2035. Surveillance of high-risk patients with cirrhosis or chronic liver disease may be one means of reducing HCC mortality, but the level of supporting evidence for international guidelines is low/moderate. This study explores the real-world experience of HCC surveillance at a tertiary referral centre. Electronic patient records for all new HCCs diagnosed between August 2012 and December 2021 were retrospectively reviewed. Patient and tumour characteristics were evaluated, including the co-existence of chronic liver disease, cancer treatment and survival, and categorised according to HCC diagnosis within or outside a surveillance programme. Patients with HCC who presented through surveillance had smaller tumours diagnosed at an earlier stage, but this did not translate into improved overall survival. All patients in surveillance had chronic liver disease, including 91% (n = 101) with cirrhosis, compared to 45% (n = 29) in the non-surveillance cohort. We propose that the immune dysfunction associated with cirrhosis predisposes patients to a more aggressive tumour biology than the largely non-cirrhotic population in the non-surveillance group.