Adherence to Hepatocellular Carcinoma Surveillance and Its Association with Tumor Stage at Diagnosis: Experience at a University Hospital

Abstract

Introduction. Hepatocellular carcinoma is the most common primary liver cancer. Surveillance using abdominal ultrasound and alpha-fetoprotein testing allows for its detection in early stages. The objective of this study was to evaluate adherence to hepatocellular carcinoma surveillance in patients with cirrhosis and to analyze its association with tumor stage, liver function, and alpha-fetoprotein levels at the time of diagnosis.

Methods. This retrospective study included patients with cirrhosis and a diagnosis of hepatocellular carcinoma between 2000 and 2024. A patient was considered adherent if they had undergone at least one surveillance examination via abdominal ultrasound and alpha-fetoprotein testing within the six months prior to diagnosis. Demographic variables, etiology, liver function, tumor stage according to the Barcelona Clinic Liver Cancer (BCLC) classification, and alpha-fetoprotein levels were analyzed.

Results. A total of 121 patients were included; the mean age was 64.3 ± 10.6 years, and 73.6% were male. Thirty-three percent (40/121) met the adherence criteria. Adherent patients had a higher proportion of Child-Pugh A (60% vs. 24.7%; p < 0.001), were more frequently diagnosed with BCLC stage A (37.5% vs. 17.3%; p = 0.023), and showed a lower median AFP level in the descriptive analysis (7 vs. 21 ng/mL). However, in the multivariable analysis adjusted for age, sex, liver function, etiology, and year of diagnosis, the association between adherence and BCLC stage A diagnosis did not reach statistical significance.

Conclusions. Adherence to hepatocellular carcinoma surveillance was low. In the unadjusted analysis, adherent patients were more frequently diagnosed at BCLC stage A and, descriptively, had a lower median alpha-fetoprotein level. The association between adherence and diagnosis at BCLC stage A did not remain statistically significant after adjustment for relevant clinical variables.