| Abstract: | Objective: Current guidelines recommend screening for hepatocellular carcinoma (HCC) in high risk populations. However, the effectiveness of screening in reducing mortality has been challenged. In addition, it is unclear which subgroups benefit most from HCC screening. Design: This nationwide cohort study identified a total of 54,329 newly diagnosed HCC patients between January 1, 2002 and December 31, 2007. These HCC patients were classified into the following cohorts according to the time intervals in which they received ultrasonography screening: 0-6 months (6M), 6-12 months (12M), 1-2 years (2Y), 2-3 years (3Y), 3-5 years (5Y), and not screened within 5 years (never screened). The chance to receive curative therapy and 5-year cumulative mortalities were calculated after adjusting for leadtime bias. Results: Chances to receive curative therapy among the 6M, 12M, 2Y, 3Y, 5Y and never screened cohorts were 24.0% (95%CI, 23.4-24.6%), 26.5% (95%CI, 25.2-27.7%), 22.7% (95%CI, 21.6-23.9%), 21.0% (95%CI, 19.6-20.0%), 18.8% (95%CI, 17.5-20.0%), and 17.8% (95%CI, 17.2-18.3%), respectively. Compared with the 6M cohort, adjusted HRs of mortality for 12M, 2Y, 3Y, 5Y and never screened cohorts were 1.09 (95%CI, 1.05-1.13), 1.19 (95%CI, 1.15-1.24), 1.27 (95%CI, 1.22-1.33), 1.40 (95%CI, 1.35-1.46), and 1.69 (95%CI, 1.64-1.75) (all P<0.001), respectively. On multivariable subgroup analyses, associations between shorter screening intervals and better survival were observed in nearly all subgroups, especially in younger patients, patients without diabetes, and patients with hepatitis B infection. Conclusion: Shorter ultrasonography screening intervals are associated with higher chance to receive curative therapy and reduced overall mortality in HCC patients in a dose-dependent manner. |
