Improved Detection of Hepatocellular Carcinoma by Dynamic CT in Cirrhotic Patients With Chronic Hepatitis B: A Multi-Center Study.

BACKGROUND & AIMS: Current guidelines for chronic hepatitis B (CHB) patients are to undergo surveillance for hepatocellular carcinoma (HCC) with 6-monthly ultrasonography (US). However, sensitivities of US to detect early-stage HCC in cirrhotic patients are suboptimal. We aimed to compare overall survival and detection rates of very-early-stage HCC in 2 groups: group A, undergoing 6-monthly US versus group B, undergoing 6-monthly US alternating with dynamic computed tomography (CT). METHODS: This retrospective multi-center study assessed 1,235 cirrhotic patients with CHB under entecavir/tenofovir therapy from 2007 to 2016. The primary endpoint was overall survival rates between the two groups. The Cox proportional hazards model and propensity-score matching analyses were used to assess the effect of surveillance modalities on overall survival and detection of BCLC 0 HCC after balancing. RESULTS: During a median follow-up of 4.5 years, 10-year cumulative HCC incidence rates of 16.3% were significantly higher in group B (n=576) than 13.7% in group A (n=659; P<0.001). However, in patients with HCC, 10-year overall survival rates of 85.1% were significantly higher in group B than 65.6% in group A (P=0.001 by log-rank test). CT exam alternating with US was independently associated with reduced overall mortality (HR 0.47, P=0.02). Cumulative incidence of Barcelona Clinic Liver Cancer stage (BCLC) 0 HCC were significantly higher in group B than in group A (HR 2.82, P<0.001). CONCLUSION: In cirrhotic patients with CHB, dynamic CT exam alternating with US led to higher detection rates of very-early-stage HCC and benefit of overall survival compared to US exams.