Gut Online First, published on February 10, 2015 as 10.1136/gutjnl-2014-308786 Hepatology
ORIGINAL ARTICLE
Association between ultrasonography screening and mortality in patients with hepatocellular carcinoma: a nationwide cohort study Chun-Ying Wu,1,2,3,4,5 Yao-Chun Hsu,6 Hsiu J Ho,1 Yi-Ju Chen,2 Teng-Yu Lee,1 Jaw-Town Lin6,7,8 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ gutjnl-2014-308786). For numbered affiliations see end of article. Correspondence to Professor Chun-Ying Wu, Division of Gastroenterology, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Avenue, Taichung 407, Taiwan; [email protected] Wu CY and Lin JT contributed equally as corresponding authors. Received 10 November 2014 Revised 17 January 2015 Accepted 19 January 2015
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 52 823 newly diagnosed HCC patients between 1 January 2002 and 31 December 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), 7–12 months (12M), 13–24 months (24M), 25–36 months (36M) and not screened within 3 years (never screened). The chance to receive curative therapy and 5-year cumulative mortalities were calculated after adjusting for lead-time bias. Results Chances to receive curative therapy among the 6M, 12M, 24M, 36M and never screened cohorts were 24.3% (95% CI 23.7% to –24.9%), 26.9% (95% CI 25.7% to 28.2%), 22.9% (95% CI 21.8% to 24.1%), 21.3% (95% CI 19.9% to 22.8%) and 18.3% (95% CI 17.8% to 18.8%), respectively. Compared with the 6M cohort, adjusted HRs of mortality for the 12M, 24M, 36M and never screened cohorts were 1.11 (95% CI 1.07 to 1.15), 1.23 (95% CI 1.19 to 1.28), 1.31 (95% CI 1.26 to 1.37) and 1.47 (95% CI 1.43 to 1.51) (all p
ORIGINAL ARTICLE
Association between ultrasonography screening and mortality in patients with hepatocellular carcinoma: a nationwide cohort study Chun-Ying Wu,1,2,3,4,5 Yao-Chun Hsu,6 Hsiu J Ho,1 Yi-Ju Chen,2 Teng-Yu Lee,1 Jaw-Town Lin6,7,8 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ gutjnl-2014-308786). For numbered affiliations see end of article. Correspondence to Professor Chun-Ying Wu, Division of Gastroenterology, Taichung Veterans General Hospital, No. 1650, Section 4, Taiwan Avenue, Taichung 407, Taiwan; [email protected] Wu CY and Lin JT contributed equally as corresponding authors. Received 10 November 2014 Revised 17 January 2015 Accepted 19 January 2015
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 52 823 newly diagnosed HCC patients between 1 January 2002 and 31 December 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), 7–12 months (12M), 13–24 months (24M), 25–36 months (36M) and not screened within 3 years (never screened). The chance to receive curative therapy and 5-year cumulative mortalities were calculated after adjusting for lead-time bias. Results Chances to receive curative therapy among the 6M, 12M, 24M, 36M and never screened cohorts were 24.3% (95% CI 23.7% to –24.9%), 26.9% (95% CI 25.7% to 28.2%), 22.9% (95% CI 21.8% to 24.1%), 21.3% (95% CI 19.9% to 22.8%) and 18.3% (95% CI 17.8% to 18.8%), respectively. Compared with the 6M cohort, adjusted HRs of mortality for the 12M, 24M, 36M and never screened cohorts were 1.11 (95% CI 1.07 to 1.15), 1.23 (95% CI 1.19 to 1.28), 1.31 (95% CI 1.26 to 1.37) and 1.47 (95% CI 1.43 to 1.51) (all p
