Taylor, EJ, Jones, RL, Guthrie, JA et al. (1 more author) (2017) Modeling the benefits and harms of surveillance for hepatocellular carcinoma: Information to support informed choices. Hepatology, 66 (5). pp. 1546-1555. ISSN 0270-9139
Abstract
Surveillance by ultrasonography for hepatocellular carcinoma (HCC) for individuals with cirrhosis is recommended. There is debate regarding the effectiveness of surveillance in reducing mortality, and there is little information on the harms available to patients considering surveillance. The aim of this study was to provide estimates of both the benefit and harms of surveillance. A Markov model was built to simulate outcomes of individuals aged 50 years with well-compensated cirrhosis entering surveillance. Following identification of a focal lesion by ultrasound surveillance, further investigations were defined by the European Association for the Study of the Liver/European Organization for Research and Treatment of Cancer recall policy. Benefit and harm outcomes are expressed per 1,000 patients over 5 years. For every 1,000 patients in surveillance over 5 years, there are 13 fewer deaths (95% confidence interval [CI], 12-14) compared with no surveillance, equating to a number needed to screen to prevent one death from HCC of 77. In comparison, many more individuals experienced harm through surveillance. For every 1,000 patients, 150 (95% CI, 146-154) had one or more false-positive tests equating to a number needed to harm from surveillance of 7. As a consequence of a false-positive test, 65 individuals required at least one additional unnecessary computed tomography scan or magnetic resonance imaging and 39 required an unnecessary liver biopsy according to the recall policy. Surveillance benefits were sensitive to the incidence of HCC and the mortality benefit achieved by treatment. Harms were sensitive to the rates of false-positive testing and the frequency of liver biopsy. Conclusion: There is a balance between the small absolute mortality benefit to surveillance for HCC and the numerically more frequent harms resulting from false-positive testing. Implementation of the recently revised American Association for the Study of Liver Diseases recommendations is predicted to reduce harms from unnecessary liver biopsy.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 by the American Association for the Study of Liver Diseases. This is the peer reviewed version of the following article: Taylor, E. J., Jones, R. L., Guthrie, J. A. and Rowe, I. A. (2017), Modeling the benefits and harms of surveillance for hepatocellular carcinoma: Information to support informed choices. Hepatology, 66: 1546–1555. doi:10.1002/hep.29315, which has been published in final form at https://doi.org/10.1002/hep.29315. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. Uploaded in accordance with the publisher's self-archiving policy. |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Molecular Medicine (LIMM) (Leeds) > Section of Translational Medicine (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 18 Dec 2017 16:48 |
Last Modified: | 12 Jun 2018 00:38 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1002/hep.29315 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:125331 |