Casual analysis between screening adherence and hepatocellular carcinoma staging in hepatitis B patients: a retrospective cohort study

Current clinical guidelines recommend that chronic hepatitis B patients undergo abdominal ultrasound and alpha-fetoprotein testing every six months. However, most of these patients exhibit insufficient screening adherence. This study aimed to determine whether screening adherence directly affects the tumor stage in patients with chronic hepatitis B-related hepatocellular carcinoma. This single-center, observational, retrospective cohort study enrolled 150 patients with chronic hepatitis B-related hepatocellular carcinoma who were treated at the Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-sen University, from 2008 to 2023. Stabilized inverse probability weighting was used to balance confounding factors. Screening adherence was defined as the completion rate of regular semiannual screenings. It was calculated as (6 × number of screenings) ÷ follow-up duration in months. The primary outcome measures were advanced hepatocellular carcinoma (China Liver Cancer Staging IIb–IV) and maximum tumor diameter. Multivariate regression models were constructed to assess causal associations. Confounding factors included age, gender, cirrhosis, nucleos(t)ide analogue therapy, alcohol consumption, hepatitis B e antigen, hepatitis B virus DNA, and alpha-fetoprotein. After inverse probability weighting, the standardized mean differences for all confounding factors were less than 0.1. Weighted logistic regression revealed that screening adherence was an independent protective factor against advanced hepatocellular carcinoma (OR, 0.209; 95% CI, 0.061–0.716; p = 0.013). Weighted multiple linear regression demonstrated a significant inverse correlation between screening adherence and maximum tumor diameter (coefficient, −1.851; 95% CI, −3.137 to −0.565; p = 0.005). Insufficient adherence to hepatocellular carcinoma screening among chronic hepatitis B patients results in missed optimal diagnostic windows. This significantly increases the risk of advanced cancer. All interested parties should collaborate to develop feasible strategies for improving patient adherence.