Value of HCC surveillance in a landscape of emerging surveillance options: Perspectives of a multi-stakeholder modified Delphi panel

HCC surveillance is recommended by liver professional societies but lacks broad acceptance by several primary care and cancer societies due to limitations in the existing data. We convened a diverse multidisciplinary group of cancer screening experts to evaluate current and future paradigms of HCC prevention and early detection using a rigorous Delphi panel approach. The experts had high agreement on 21 statements about primary prevention, HCC surveillance benefits, HCC surveillance harms, and the evaluation of emerging surveillance modalities. The experts agreed that current data have methodologic limitations as well as unclear generalizability to Western populations. Although a randomized clinical trial of surveillance versus no surveillance is unlikely feasible, they concurred that alternative designs, such as a comparison of 2 surveillance modalities, could provide indirect evidence of surveillance efficacy. The panel acknowledged the presence of surveillance harms, but concurred the overall value of surveillance appears high, particularly given a greater emphasis on benefits over harms by both patients and clinicians. The experts underscored the importance of a framework for measuring both benefits and harms when evaluating emerging surveillance strategies. The panel acknowledged performance metrics of emerging methods may differ from other cancer screening programs given differences in populations, including higher risk of cancer development and competing risk of morality, and differences in diagnostic workflow in patients at risk of HCC. These data provide insights into the perceived value of HCC surveillance in an era of emerging blood- and imaging-based surveillance strategies.

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Publication Details

Journal
Hepatology
Published
2024-12-18
DOI
https://doi.org/10.1097/hep.0000000000001203
Citations
8
Primary Topic
Delphi Technique in Research
Type
article
Field-Weighted Citation Impact
9.06

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article

Value of HCC surveillance in a landscape of emerging surveillance options: Perspectives of a multi-stakeholder modified Delphi panel

Nicholas J. Shaheen, Jorge A. Marrero, Lisa Quirk, Amit G. Singal et al.
8 citations
Hepatology
Delphi Technique in Research
9.06
article

Value of HCC surveillance in a landscape of emerging surveillance options: Perspectives of a multi-stakeholder modified Delphi panel

Nicholas J. Shaheen, Jorge A. Marrero, Lisa Quirk, Amit G. Singal, Ju Dong Yang, Claude B. Sirlin, George N. Ioannou, Justin Boike, Elizabeth C. Verna, Neehar D. Parikh, Anjana Pillai, Ziding Feng, Victoria Chernyak, Fasiha Kanwal, Neil Mehta, Giamarqo Giamarqo, Sachin B. Wani, Aasma Shaukat, Andrea Wilson Woods, Sarah Manes
article en
8 citations

Abstract

HCC surveillance is recommended by liver professional societies but lacks broad acceptance by several primary care and cancer societies due to limitations in the existing data. We convened a diverse multidisciplinary group of cancer screening experts to evaluate current and future paradigms of HCC prevention and early detection using a rigorous Delphi panel approach. The experts had high agreement on 21 statements about primary prevention, HCC surveillance benefits, HCC surveillance harms, and the evaluation of emerging surveillance modalities. The experts agreed that current data have methodologic limitations as well as unclear generalizability to Western populations. Although a randomized clinical trial of surveillance versus no surveillance is unlikely feasible, they concurred that alternative designs, such as a comparison of 2 surveillance modalities, could provide indirect evidence of surveillance efficacy. The panel acknowledged the presence of surveillance harms, but concurred the overall value of surveillance appears high, particularly given a greater emphasis on benefits over harms by both patients and clinicians. The experts underscored the importance of a framework for measuring both benefits and harms when evaluating emerging surveillance strategies. The panel acknowledged performance metrics of emerging methods may differ from other cancer screening programs given differences in populations, including higher risk of cancer development and competing risk of morality, and differences in diagnostic workflow in patients at risk of HCC. These data provide insights into the perceived value of HCC surveillance in an era of emerging blood- and imaging-based surveillance strategies.

HepatologyVol. 82(3)
Northwestern University (US), University of North Carolina at Chapel Hill (US), Cedars-Sinai Medical Center (US), University of Denver (US), Cape Town HVTN Immunology Laboratory / Hutchinson Centre Research Institute of South Africa (ZA), University of San Diego (US), University of California, San Francisco (US), Baylor College of Medicine (US), University of Michigan (US), Blue Cross Blue Shield Association (US), University of California San Diego (US), University of Chicago (US), Fred Hutch Cancer Center (US), Liver Institute Northwest (US), Department of Veterans Affairs (AU), New York University (US), Columbia University (US), University of Pennsylvania (US), The University of Texas Southwestern Medical Center (US), University of Colorado Denver (US), Philadelphia University (US)
Pfizer, Cancer Prevention and Research Institute of Texas, Gilead Sciences, University of Cincinnati, Castle Biosciences, National Institutes of Health, National Cancer Institute
Openalex Percentile: Top 2%
Delphi Technique in Research
9.06
DOIOpen Access PDFOpenAlex
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