Efficacy of Hepatocellular Carcinoma Screening with Abdominal Ultrasonography for Family Relatives of Index Cases

Background and Aim: The invitation of family relatives of index Hepatocellular Carcinoma (HCC) cases to undergo Ultrasonography (US) examination may provide an alternative approach to be efficient in detection of HCC at early stage. It is of great interest to report long-term survival by detection modes and also the efficacy of US in reducing mortality from HCC with adjustment for other significant factors and lead-time using the data from Taiwan Multicentre Cancer Screening (TAMCAS) project that is a screening program for three cancers (breast, colorectal, and liver cancer). For liver cancer screening program, family relatives of index HCC cases were invited to have the uptake of ultrasound screening. We aimed to assess the efficacy of ultrasound screening for first-and second-degree relatives of HCC index cases.Materials and Methods: A total of 20,348 first- or second-degree relatives of patients with HCC diagnosed in multiple hospitals were enrolled between 1992 and 1997 has been followed up over 15 years since 1992. Cumulative survival rates of HCC by detection modes are presented. We used Cox proportional hazards regression models to assess the efficacy of US in reducing mortality from HCC.Results: The 1-year, 3-year, 5-year, 10-year and 15-year case-specific survival (CSS) rates of patients with HCC were 65%, 48%, 40.3%, 32.8% and 30.9%, respectively. Clinically-detected HCC cases (including interval cancer and post-screening cancer) had lower survival than screen-detected HCC cases. By comparing the hazard rate of the screened group (screen-detected cases plus interval cancers) with that of post-screening group, the efficacy of screening with ultrasonography conferred a 27% (95% confidence interval: 1%-46%)) reduction in mortality from HCC after adjusting for other biological factors, degrees of relative relationship and lead-time.Conclusions: Our study reveals ultrasound screening for family members of HCC cases can lead to a third of mortality reduction, which suggests the intensive screening seems necessary for first-degree or second-degree of family relatives of HCC index cases.