Rates of surveillance and management of hepatocellular carcinoma in patients evaluated at a liver transplant center

Janice Jou, Po Hung Chen, Alison Jazwinski, Iliana Bouneva, Alastair D. Smith, Andrew J. Muir

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objectives: The treatment of choice for HCC with cirrhosis is liver transplantation (LT). We assessed if patients evaluated for hepatocellular carcinoma are being diagnosed by surveillance, the proportion of patients meeting Milan criteria at diagnosis, and rates of liver transplantation. Methods: All HCC cases in cirrhotic patients at Duke University Medical Center in the MELD era (Feb 2002-Oct 2008) were identified. Surveillance was defined as an imaging exam for detection of HCC in the 12 months prior to diagnosis of HCC. Logistic regression was used to examine predictors of LT. Results: There were 319 cases meeting diagnostic criteria for HCC. Only 30.7% were diagnosed by surveillance and 43.7% met Milan criteria at diagnosis. Patients diagnosed by surveillance were more likely to meet Milan criteria and to receive LT (p <0.0001 for both outcomes). Surveillance was associated with higher rates of LT with an OR 2.6 (95% CI 1.2-5.7, p = 0.02). Patients managed by a hepatologist were more likely to be diagnosed by surveillance (65.9 vs. 19.0%, p <0.0001). Patients meeting Milan criteria managed by a hepatologist were more likely to receive LT than those referred from other providers (26.4 vs. 8%, p = 0.009). Conclusions: A minority of HCC cases in cirrhotic patients were diagnosed by surveillance, and only 12.5% underwent LT. Patients diagnosed by surveillance were more likely to meet Milan criteria and to undergo LT. These findings highlight the need for increased identification of patients with chronic liver disease and for subsequent referral to hepatologists for enrollment in HCC surveillance programs.

Original languageEnglish (US)
Pages (from-to)3591-3596
Number of pages6
JournalDigestive Diseases and Sciences
Volume55
Issue number12
DOIs
StatePublished - Dec 2010
Externally publishedYes

Fingerprint

Hepatocellular Carcinoma
Liver Transplantation
Transplants
Liver
Liver Diseases
Fibrosis
Chronic Disease
Referral and Consultation
Logistic Models
Gastroenterologists

Keywords

  • Hepatocellular carcinoma
  • Liver cirrhosis
  • Liver transplantation
  • Quality of health care

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology

Cite this

Rates of surveillance and management of hepatocellular carcinoma in patients evaluated at a liver transplant center. / Jou, Janice; Chen, Po Hung; Jazwinski, Alison; Bouneva, Iliana; Smith, Alastair D.; Muir, Andrew J.

In: Digestive Diseases and Sciences, Vol. 55, No. 12, 12.2010, p. 3591-3596.

Research output: Contribution to journalArticle

Jou, Janice ; Chen, Po Hung ; Jazwinski, Alison ; Bouneva, Iliana ; Smith, Alastair D. ; Muir, Andrew J. / Rates of surveillance and management of hepatocellular carcinoma in patients evaluated at a liver transplant center. In: Digestive Diseases and Sciences. 2010 ; Vol. 55, No. 12. pp. 3591-3596.
@article{999be900611f4cd98bef048cb83ef97c,
title = "Rates of surveillance and management of hepatocellular carcinoma in patients evaluated at a liver transplant center",
abstract = "Objectives: The treatment of choice for HCC with cirrhosis is liver transplantation (LT). We assessed if patients evaluated for hepatocellular carcinoma are being diagnosed by surveillance, the proportion of patients meeting Milan criteria at diagnosis, and rates of liver transplantation. Methods: All HCC cases in cirrhotic patients at Duke University Medical Center in the MELD era (Feb 2002-Oct 2008) were identified. Surveillance was defined as an imaging exam for detection of HCC in the 12 months prior to diagnosis of HCC. Logistic regression was used to examine predictors of LT. Results: There were 319 cases meeting diagnostic criteria for HCC. Only 30.7{\%} were diagnosed by surveillance and 43.7{\%} met Milan criteria at diagnosis. Patients diagnosed by surveillance were more likely to meet Milan criteria and to receive LT (p <0.0001 for both outcomes). Surveillance was associated with higher rates of LT with an OR 2.6 (95{\%} CI 1.2-5.7, p = 0.02). Patients managed by a hepatologist were more likely to be diagnosed by surveillance (65.9 vs. 19.0{\%}, p <0.0001). Patients meeting Milan criteria managed by a hepatologist were more likely to receive LT than those referred from other providers (26.4 vs. 8{\%}, p = 0.009). Conclusions: A minority of HCC cases in cirrhotic patients were diagnosed by surveillance, and only 12.5{\%} underwent LT. Patients diagnosed by surveillance were more likely to meet Milan criteria and to undergo LT. These findings highlight the need for increased identification of patients with chronic liver disease and for subsequent referral to hepatologists for enrollment in HCC surveillance programs.",
keywords = "Hepatocellular carcinoma, Liver cirrhosis, Liver transplantation, Quality of health care",
author = "Janice Jou and Chen, {Po Hung} and Alison Jazwinski and Iliana Bouneva and Smith, {Alastair D.} and Muir, {Andrew J.}",
year = "2010",
month = "12",
doi = "10.1007/s10620-010-1366-3",
language = "English (US)",
volume = "55",
pages = "3591--3596",
journal = "American Journal of Digestive Diseases and Nutrition",
issn = "0163-2116",
publisher = "Plenum Publishers",
number = "12",

}

TY - JOUR

T1 - Rates of surveillance and management of hepatocellular carcinoma in patients evaluated at a liver transplant center

AU - Jou, Janice

AU - Chen, Po Hung

AU - Jazwinski, Alison

AU - Bouneva, Iliana

AU - Smith, Alastair D.

AU - Muir, Andrew J.

PY - 2010/12

Y1 - 2010/12

N2 - Objectives: The treatment of choice for HCC with cirrhosis is liver transplantation (LT). We assessed if patients evaluated for hepatocellular carcinoma are being diagnosed by surveillance, the proportion of patients meeting Milan criteria at diagnosis, and rates of liver transplantation. Methods: All HCC cases in cirrhotic patients at Duke University Medical Center in the MELD era (Feb 2002-Oct 2008) were identified. Surveillance was defined as an imaging exam for detection of HCC in the 12 months prior to diagnosis of HCC. Logistic regression was used to examine predictors of LT. Results: There were 319 cases meeting diagnostic criteria for HCC. Only 30.7% were diagnosed by surveillance and 43.7% met Milan criteria at diagnosis. Patients diagnosed by surveillance were more likely to meet Milan criteria and to receive LT (p <0.0001 for both outcomes). Surveillance was associated with higher rates of LT with an OR 2.6 (95% CI 1.2-5.7, p = 0.02). Patients managed by a hepatologist were more likely to be diagnosed by surveillance (65.9 vs. 19.0%, p <0.0001). Patients meeting Milan criteria managed by a hepatologist were more likely to receive LT than those referred from other providers (26.4 vs. 8%, p = 0.009). Conclusions: A minority of HCC cases in cirrhotic patients were diagnosed by surveillance, and only 12.5% underwent LT. Patients diagnosed by surveillance were more likely to meet Milan criteria and to undergo LT. These findings highlight the need for increased identification of patients with chronic liver disease and for subsequent referral to hepatologists for enrollment in HCC surveillance programs.

AB - Objectives: The treatment of choice for HCC with cirrhosis is liver transplantation (LT). We assessed if patients evaluated for hepatocellular carcinoma are being diagnosed by surveillance, the proportion of patients meeting Milan criteria at diagnosis, and rates of liver transplantation. Methods: All HCC cases in cirrhotic patients at Duke University Medical Center in the MELD era (Feb 2002-Oct 2008) were identified. Surveillance was defined as an imaging exam for detection of HCC in the 12 months prior to diagnosis of HCC. Logistic regression was used to examine predictors of LT. Results: There were 319 cases meeting diagnostic criteria for HCC. Only 30.7% were diagnosed by surveillance and 43.7% met Milan criteria at diagnosis. Patients diagnosed by surveillance were more likely to meet Milan criteria and to receive LT (p <0.0001 for both outcomes). Surveillance was associated with higher rates of LT with an OR 2.6 (95% CI 1.2-5.7, p = 0.02). Patients managed by a hepatologist were more likely to be diagnosed by surveillance (65.9 vs. 19.0%, p <0.0001). Patients meeting Milan criteria managed by a hepatologist were more likely to receive LT than those referred from other providers (26.4 vs. 8%, p = 0.009). Conclusions: A minority of HCC cases in cirrhotic patients were diagnosed by surveillance, and only 12.5% underwent LT. Patients diagnosed by surveillance were more likely to meet Milan criteria and to undergo LT. These findings highlight the need for increased identification of patients with chronic liver disease and for subsequent referral to hepatologists for enrollment in HCC surveillance programs.

KW - Hepatocellular carcinoma

KW - Liver cirrhosis

KW - Liver transplantation

KW - Quality of health care

UR - http://www.scopus.com/inward/record.url?scp=78649331560&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78649331560&partnerID=8YFLogxK

U2 - 10.1007/s10620-010-1366-3

DO - 10.1007/s10620-010-1366-3

M3 - Article

C2 - 20683659

AN - SCOPUS:78649331560

VL - 55

SP - 3591

EP - 3596

JO - American Journal of Digestive Diseases and Nutrition

JF - American Journal of Digestive Diseases and Nutrition

SN - 0163-2116

IS - 12

ER -