RESUMEN
Purpose: Surveillance for hepatocellular carcinoma (HCC) is recommended in at-risk patients, but its effectiveness in Western populations has been questioned. The purpose was to evaluate the effect of surveillance in patients with HCC in a Northern European setting. Patients and Methods: Data on patients diagnosed with HCC between 2009 and 2019 were collected from the nationwide Swedish National Registry for Tumors of the Liver and Bile Ducts (SweLiv). Patients who had undergone HCC surveillance were compared to those who had not (but had an obvious indication for surveillance, ie, liver cirrhosis or hepatic porphyria and an age of ≥50 years) regarding etiology, tumor burden, presence of extrahepatic spread, treatment and lead-time adjusted overall survival. Results: A total of 4979 patients with index HCC were identified and information regarding surveillance was available in 4116 patients. Among these, 1078 had got their HCC diagnosis during surveillance, whereas 1647 had been diagnosed without surveillance despite a presumed indication. The most common underlying etiologies for HCC were hepatitis C (28.2%) and alcoholic liver disease (26.9%), and 94.8% had cirrhosis. The surveillance cohort more frequently met the University of California San Francisco-criteria (79% vs 53%, p <0.001), more often received a potentially curative treatment (62% vs 28%, p <0.001) and had less extrahepatic spread (7.6% vs 22.4% p <0.001). After adjustment for lead-time bias (sojourn time of 270 days), the surveillance group had a significantly longer estimated median survival time than the non-surveillance group (34 months vs 11 months, p <0.001). A multivariable cox regression analysis showed an adjusted hazard ratio of 0.59 (95% CI 0.51-0.67) in favor of surveillance. Conclusion: Surveillance for HCC in at-risk patients is associated with diagnosis at an earlier tumor stage, treatment with curative intent and with improved lead-time adjusted overall survival. These findings encourage HCC surveillance of at-risk patients also in a Western population.
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Aim of the study: Oesophageal and gastric varices are well-known causes of morbidity and mortality in patients with liver cirrhosis. The aim of this retrospective observational study was to analyse clinical characteristics and outcomes for patients with oesophageal and gastric varices at Norrland's University Hospital, Umeå, Sweden. Material and methods: Data from medical records were collected retrospectively from 246 patients with oesophageal and gastric varices between 2006 and 2019. Results: At the end of the study 60.1% of the patients had died at a median age of 69 years (range 26-95). Mortality of patients with gastro-oesophageal varices was significantly greater than that of the general population. Median survival from the time of variceal diagnosis was 59 months (confidence interval [CI] 95%: 45-73 months). Five-year and 10-year cumulative survival rates in the entire cohort were 49.7% and 27.7%, respectively, with no sex-related differences. The highest mortality rate was seen in alcoholic cirrhosis with concomitant hepatitis. Mortality was higher in Child-Turcotte-Pugh (CTP) B and C compared to CTP A. Liver failure and liver cancer were the most common causes of death (43.8%). Thirty-one percent of the patients had a variceal haemorrhage. Eleven percent were subjected to liver transplantation, whereas 3.9% of the patients had been submitted to a transjugular intrahepatic portosystemic shunt (TIPS) procedure. Conclusions: Despite the latest therapeutic advances, the survival of patients with gastro-oesophageal varices remains significantly reduced. All-cause mortality was significantly related to CTP class, aetiology, occurrence of variceal bleeding, whether variceal bleeding was the primary symptom and whether patients had undergone liver transplantation or not.
