Trends and Patterns of Utilization in Post-treatment Surveillance Imaging Among Patients Treated for Hepatocellular Carcinoma

Omar Hyder, Rebecca M. Dodson, Matthew Weiss, David P. Cosgrove, Joseph M. Herman, Jean Francois H. Geschwind, Ihab R. Kamel, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Little is known about the patterns of utilization of surveillance imaging after treatment of hepatocellular carcinoma (HCC). We sought to define population-based patterns of surveillance and investigate if intensity of surveillance impacted outcome following HCC treatment. Methods: The Surveillance, Epidemiology, and End Results-Medicare database was used to identify patients with HCC diagnosed between 1998 and 2007 who underwent resection, ablation, or intra-arterial therapy (IAT). The association between imaging frequency and long-term survival was analyzed. Results: Of the 1,467 patients, most underwent ablation only (41.5 %), while fewer underwent liver resection only (29.6 %) or IAT only (18.3 %). Most patients had at least one CT scan (92.7 %) during follow-up, while fewer had an MRI (34.1 %). A temporal trend was noted with more frequent surveillance imaging obtained in post-treatment year 1 (2.5 scans/year) vs. year 5 (0.9 scans/year; P = 0.01); 34.5 % of alive patients had no imaging after 2 years. Frequency of surveillance imaging correlated with procedure type (total number of scans/5 years, resection, 4.7; ablation, 4.9; IAT, 3.7; P < 0.001). Frequency of surveillance imaging was not associated with a survival benefit (three to four scans/year, 49.5 months vs. two scans/year, 71.7 months vs. one scan/year, 67.6 months; P = 0.01) Conclusion: Marked heterogeneity exists in how often surveillance imaging is obtained following treatment of HCC. Higher intensity imaging does not confer a survival benefit.

Original languageEnglish (US)
Pages (from-to)1774-1783
Number of pages10
JournalJournal of Gastrointestinal Surgery
Volume17
Issue number10
DOIs
StatePublished - Oct 1 2013

Keywords

  • Hepatocellular carcinoma
  • Imaging
  • Recurrence
  • Surgery
  • Surveillance

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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