W1794 Assessment of the Development of Hepatocellular Carcinoma in the Hepatitis C Virus Eradicated Patients After Interferon Therapy

Background: About 70-90% of all hepatocellular cancer (HCC) occur within an established background of chronic liver disease, especially cirrhosis. Surveillance in high risk patients has been recommended, cost-efficacy is uncertain. AIM: To retrospectively evaluate the impact of biannual HCC screening with alpha-fetoprotein and imaging at a VA medical center with introduction of a dedicated hepatitis C team in 2003. Method: Patients with liver masses between January, 1998 and December, 2007 were identified with local tumor registry data. Retrospective data abstraction from electronic medical records was performed and HCC cases were confirmed. Data including gender, age, body mass index (BMI), hepatitis B, C serology, alcohol use, tumor stage, survival, treatment, and pathology report were documented in excel format. Probability curves obtained with Kaplan Meier method were compared using the Log-Rank test. Patients were divided in a preand post-HCC screening group. Result: Fifty-one cases of liver masses were identified, 44 cases were confirmed HCC and used for further analysis. Mean survival was 10.1 months in unscreened patients (95% confidence interval [CI], 2.6-17.6), and 10.5 months in the screened group (95% CI, 6.015.0) (p .45). Kaplan Meyer overall survival for stage I and II patients was 20% and 21%, respectively and declines to 16% and 13% in stage III and IV. Survival rate for patients with surgery was 40% and declined considerably with local treatment. Only 41% of HCC were single lesion; 69%weremultifocal lesion. All 28 patients who did not receive surveillance for HCC were diagnosed before 2003. Since 2003, all HCC cases were captured by surveillance. Ten patients were diagnosed with local HCC stages (I-IIIA), 2 with advanced stage (IIIB IV), 2 had an unknown stage. In the unscreened group 15 patients were diagnosed with advanced tumor stage (IIIC IV), 4 had unknown stage. Alcohol use was common (86%). HCV positive tested 26% and 26% were not tested in the pre-screening group; 34% and 16% in the post-screening group, respectively. From multiple regression analysis the only independent predictor of survival was tumor stage (I-II versus III-IV) at the time of diagnosis, but significance (p .075) could not be established likely due to small sample size. Conclusion: A dedicated hepatitis C team accomplished biannual HCC surveillance in patients at risk which led to diagnosis at an earlier stage (62.5 % versus 32%) however did not improve overall survival. Cost-efficacy of HCC screening in the veteran's population needs to be further evaluated.