Language
English
Publication Date
3-25-2026
Journal
JHEP Reports
DOI
10.1016/j.jhepr.2026.101831
PMID
41895663
Abstract
Background: The risk of hepatocellular carcinoma (HCC) and net benefit of surveillance may differ between patients with cirrhosis. We compared the benefits and harms of HCC surveillance across risk strata in patients with cirrhosis.
Methods: We leveraged a cohort of patients with cirrhosis from a pragmatic RCT of HCC surveillance outreach enrolled between March 2018 and April 2021. Patients were stratified into low-, intermediate-, and high-risk categories based on published thresholds for three validated clinical risk scores. We calculated HCC incidence rates and moderate-to-severe physical harms for each risk stratum.
Results: Of 2142 patients with cirrhosis followed for a median of 36 months, 84 developed HCC and 90 (4.2%) experienced moderate-to-severe physical harm. The risk scores each achieved moderate discrimination for the prediction of HCC, with c-statistics ranging from 0.60 to 0.68. HCC incidence significantly increased from low- to high-risk categories across all clinical risk scores, whereas surveillance-related harms were similar across all risk strata. The net benefit (weighted benefit vs. harm assessment) was highest for high-risk stratum (range 2.8 to 3.9) and lowest for low-risk stratum (range -0.3 to 0.1), indicating the greatest net benefit for high-risk patients and less clear benefit in low-risk patients. Despite variation in the overall value of surveillance across risk categories, adherence to surveillance was low (median proportion time covered by imaging: 32.3%) and not proportional to HCC risk.
Conclusion: The net benefit of HCC surveillance significantly differs by HCC risk category in patients with cirrhosis, providing an impetus for risk-stratified surveillance approaches.
Clinical trials number: NCT02582918 IMPACT AND IMPLICATIONS: Surveillance is recommended in all patients with cirrhosis, although its net benefit may differ between patients based on risk of HCC. Using 3 validated clinical risk scores in 2142 patients with cirrhosis followed for a median of 36 months, we found HCC incidence significantly increased from low- to high-risk categories, whereas surveillance-related harms were similar across all risk strata. Therefore, the net benefit of HCC surveillance was greatest for high-risk individuals and lowest for low-risk stratum. These data provide an impetus to transition from one-size-fits-all surveillance to a risk-stratified or precision approach.
Keywords
cirrhosis, liver cancer, net benefit, precision screening, risk stratification
Published Open-Access
yes
Recommended Citation
Patel, Akash; Gavrila, Elena; Yekkaluri, Sruthi; et al., "Net Benefit of Surveillance Varies by Hepatocellular Carcinoma Risk in Patients With Cirrhosis" (2026). Faculty, Staff and Students Publications. 6798.
https://digitalcommons.library.tmc.edu/baylor_docs/6798