Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis, Identifying Gaps in Clinical Practice

Background:Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide, with rising mortality rates in the United States. Early detection of HCC through routine screening significantly improves survival rates in patients with cirrhosis. Current guidelines recommend bi-annual screening using abdominal ultrasound with or without serum AFP levels; however, adherence to these guidelines is suboptimal in clinical practice. Methods:We conducted a retrospective study of 320 adult patients diagnosed with HCC at our institution between January 1, 2023, and July 31, 2023. Patients aged >22 years were included, and their medical records were reviewed to evaluate routine surveillance adherence. Results:A total of 461 patients were initially identified for the study, with 320 meeting the inclusion criteria. Adherence to AFP screening also varied significantly based on PCP recommendations. Patients advised by their PCP to undergo AFP testing were likelier to adhere to recommended screening schedules. While 50.94% of patients with PCP recommendations had AFP screenings twice yearly, this rate decreased to 17.86% in patients without recommendations. The involvement of the gastroenterology (GI) team significantly impacted adherence to ultrasound and AFP follow-up. Patients under the care of the GI team demonstrated substantially higher rates of both ultrasound (89.47%) and AFP (87.22%) follow-up compared to those not consulting with the GI team (49.73% and 59.36%, respectively). Conclusions:Our study underscores the need for current HCC surveillance adherence. When primary care physicians and gastroenterology teams actively recommend screening, ultrasound and AFP follow-ups improve. This highlights the importance of a comprehensive, multidisciplinary approach in enhancing HCC surveillance and screening compliance.