Comparison of the Effects of Ultrasound Alone and Ultrasound, Computed Tomography, and Magnetic Resonance Imaging Combination on Surveillance in High-Risk Patients with Hepatocellular Carcinoma = Comparison of the Effects of Ultrasound Alone and Ultrasound, Computed Tomography, and Magnetic Resonance Imaging Combination on Surveillance in High-Risk Patients with Hepatocellular Carcinoma

다국어 초록 (Multilingual Abstract)

Aims: Many guidelines suggest ultrasonography at six-month intervals for patients at high risk for hepatocellular carcinoma (HCC). Nevertheless, surveillance is often performed by combining ultrasound with computed tomography (CT) and magnetic resonance imaging (MRI). This study analyzed the differences in clinical outcomes depending on whether the patients had imaging tests other than ultrasound as a surveillance test.
Methods: Patients diagnosed with chronic hepatitis B or cirrhosis at Seoul National University Hospital from 2010 to 2014 were included. Patients diagnosed with other cancers or with surveillance intervals shorter or longer than 6±1 month were excluded. Patients were divided into 2 groups: those who only had ultrasound scans (USG group) and those who had a combination of ultrasound, CT, and MRI. (combination group). Propensity score matching was applied to adjust the difference in baseline characteristics between the two groups. The difference of HCC detection, liver-related mortality and all-cause mortality between the two groups was analyzed by the Cox proportional hazards model. The difference in the stages at HCC diagnosis between the two groups was compared using Fisher’s exact test.
Results: From a total of 4,779 patients, we obtained a propensity score matched cohort of 794 patients. The combination group showed a higher risk of HCC detection than the USG group. (adjusted hazard ratio [aHR] 2.07; 95% confidence interval [CI] 1.21-3.54) The combination group showed more very early stages at the time of HCC diagnosis based on the Barcelona Clinic Liver Cancer staging system. (Fisher’s exact test P=0.03). Liver-related mortality (aHR 2.00; 95% CI 0.53-7.56) and all-cause mortality (aHR 1.06; 95% CI 0.49-2.26) were not significantly different between the two groups.
Conclusions: Combining ultrasound, CT, and MRI as a surveillance test may detect HCC in earlier stages.