Lim Ryan Yanzhe, Koh Benjamin, Ng Cheng Han, Kulkarni Anand V, Liu Ken, Wijarnpreecha Karn, Kim Beom Kyung, Muthiah Mark D, Lee Sung Won, Zheng Ming-Hua, Kawaguchi Takumi, Takahashi Hirokazu, Huang Daniel Q
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore.
JAMA Netw Open. 2025 Jul 1;8(7):e2520294. doi: 10.1001/jamanetworkopen.2025.20294.
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.
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.
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.
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.
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.
肝细胞癌（HCC）的病因正在发生变化。鉴于该疾病病因的变化，对于HCC患者进行监测的益处是否保持一致尚不清楚。
评估HCC监测与当代一大群HCC患者生存率之间的关联。
设计、设置和参与者：这是一项回顾性队列研究，纳入了2008年1月至2023年8月期间的HCC患者。HCC患者来自新加坡、日本、韩国和澳大利亚的5个国际研究地点。该队列研究共纳入了1185名成年参与者。所有纳入的参与者都有关于是否接受监测的可用信息。数据于2024年6月26日至2025年3月6日进行分析。
主要结局是接受HCC监测与未接受监测的总体生存率。进行了多变量受限平均生存时间（RMST）分析并调整了领先时间偏倚，以评估总体生存情况。
在1185名HCC参与者中，921名（77.7%）为男性，参与者的平均（标准差）年龄为67.6（10.7）岁，平均（标准差）体重指数为25.7（5.3）。接受HCC监测的参与者（n = 975）的RMST始终更高（1年时RMST差异为0.10年[95%CI，0.06 - 0.15年]；P <.001；3年时RMST差异为0.50年[95%CI，0.32 - 0.68年]；P <.001；5年时RMST差异为0.96年[95%CI，0.64 - 1.29年]；P <.001），与未接受监测的参与者（n = 210）相比。在所有随访期间，接受监测的乙型肝炎（HBV）或丙型肝炎（HCV）患者的RMST也高于未接受监测的患者。在代谢功能障碍相关脂肪性肝病（MASLD）和酒精性肝病患者中，HCC监测与未监测在随访的前3年中RMST没有统计学上的显著差异。
这项对1185名HCC参与者的队列研究发现，HCC监测与生存率提高相关。这种生存益处对于HBV相关和HCV相关HCC患者更为显著。对于MASLD相关或酒精相关HCC患者，监测的生存益处不太一致，这可能与非病毒组相对较小的样本量有关。
