Hepatocellular Carcinoma Surveillance and Survival in a Contemporary Asia-Pacific Cohort

Abstract

Importance The etiologies of hepatocellular carcinoma (HCC) are changing. It is unclear whether the benefit of surveillance for people with HCC remains consistent given the changing etiologies of the disease. Objective To evaluate the association of HCC surveillance with the survival rates of a large contemporary cohort of people with HCC. Design, Setting, and Participants This was a retrospective cohort study that included participants with HCC between January 2008 and August 2023. Participants with HCC were identified from 5 international sites in Singapore, Japan, South Korea, and Australia. A total of 1185 adult participants were included in this cohort study. All included participants had available information regarding the presence or absence of surveillance. Data were analyzed from June 26, 2024, to March 6, 2025. Main Outcomes and Measures The primary outcome was overall survival rates with HCC surveillance vs no surveillance. Multivariable restricted mean survival time (RMST) analyses with lead-time bias adjustments were conducted to assess overall survival. Results Of 1185 participants with HCC, 921 (77.7%) were male, the mean (SD) age of the participants was 67.6 (10.7) years, and the mean (SD) body mass index was 25.7 (5.3). RMSTs were consistently higher for participants who underwent HCC surveillance (n = 975) (RMST difference at 1 year, 0.10 years [95% CI, 0.06-0.15 years]; P < .001; RMST difference at 3 years, 0.50 years [95% CI, 0.32-0.68 years]; P < .001; RMST difference at 5 years, 0.96 years [95% CI, 0.64-1.29 years]; P < .001) compared with participants who did not undergo surveillance (n = 210). RMSTs remained higher among participants with hepatitis B (HBV) or hepatitis C (HCV) who underwent surveillance compared with those with no surveillance across all follow-up periods. Among participants with metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease, there were no statistically significant differences in RMSTs in the first 3 years of follow-up between HCC surveillance and no surveillance. Conclusions and Relevance This cohort study of 1185 participants with HCC found that HCC surveillance was associated with improved survival. This survival benefit was more prominent for people with HBV-associated and HCV-associated HCC. The survival benefit of surveillance was less consistent for people with MASLD-associated or alcohol-associated HCC, which may have been related to the relatively modest sample size in the nonviral groups.