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Screening for hepatocellular carcinoma in chronic liver disease

This month's issue of the Annals of Internal Medicine reviews the benefits and harms of HCC screening in patients with chronic liver disease.

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Guidelines recommend routine screening for hepatocellular carcinoma (HCC) in high-risk patients, but the strength of evidence supporting these recommendations is unclear.

Dr Devan Kansagara and colleagues reviewed the benefits and harms of HCC screening in patients with chronic liver disease.

MEDLINE, PsycINFO, and ClinicalTrials.gov were searched from inception to 2014, including Cochrane databases to 2013, reference lists, and technical advisors.

English-language trials and observational studies comparing screening versus no screening were identified, as well as studies of harms, and trials comparing different screening intervals.

The team evaluated mortality and adverse events.

The overall strength of evidence on the effects of screening was very low
Annals of Internal Medicine

Individual-study quality and the overall strength of evidence were dual-reviewed using published criteria.

Of 13,801 citations, 22 studies met inclusion criteria.

The researchers found that the overall strength of evidence on the effects of screening was very low.

One large trial of patients with hepatitis B found decreased HCC mortality with periodic ultrasonographic screening, but the study was limited by methodological flaws.

Another trial in patients with hepatitis B found no survival benefit with periodic α-fetoprotein screening.

The team noted that in 18 observational studies, screened patients had earlier-stage HCC than clinically diagnosed patients, but lead- and length-time biases confounded the effects on mortality.

There were 2 trials that found no survival differences between shorter and longer screening intervals.

The team observed that harms of screening were not well-studied.

Dr Kansagara's team concludes, "There is very-low-strength evidence about the effects of HCC screening on mortality in patients with chronic liver disease."

"Screening tests can identify early-stage HCC, but whether systematic screening leads to a survival advantage over clinical diagnosis is uncertain."

Ann Int Med 2014: 161(4): 261-269
27 August 2014

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