Our goal was to examine rates and predictors for hepatocellular carcinoma (HCC) surveillance adherence and persistency, since studies of such adherence and persistency in patients with chronic hepatitis (CHB) are currently limited.Consecutive CHB patients (N=1329) monitored for 1 year at 4 US clinics from January 1996 to July 2013 were retrospectively studied. Surveillance adherence was evaluated based on the American Association for the Study of Liver Diseases guidelines. Kaplan-Meier method was used to analyze surveillance persistency of 510 patients who had initially fair adherence (having at least annual surveillance imaging with further follow-up).Mean age was 48, with the majority being male (58%), Asian (92%), foreign-born (95%), and medically insured (97%). Patients with cirrhosis and those seen at university liver clinics were more likely to have optimal HCC surveillance than those without cirrhosis and those seen at community clinics (38.4% vs 21.6%, P<0.001 and 33.5% vs 14.4%, P<0.001, respectively). HCC diagnosed in optimally adherent patients trended toward smaller tumor size (P<0.08). On multivariate analysis also inclusive of age, sex, clinical visits, cirrhosis, clinic setting and antiviral therapy use, strong independent predictors for having at least annual imaging were a history of more frequent clinical visits (odds ratio [OR]=2.5, P<0.001) and university-based care (OR=5.2, P<0.001). Even for those with initially fair adherence, persistency dropped to 70% at 5 years.Adherence and persistency to HCC surveillance in CHB patients is generally poor. More frequent clinic visits and university-based settings were significant and strong predictors of at least annual HCC surveillance adherence.
[1]Stanford Univ, Publ Policy Dept, Stanford, CA 94305 USA.
[2]Stanford Univ, Med Ctr, Dept Med, Palo Alto, CA 94304 USA.
[3]Stanford Univ, Med Ctr, Div Gastroenterol & Hepatol, 750 Welch Rd,Suite 210, Palo Alto, CA 94304 USA.
[4]Stanford Univ, Dept Biol, Stanford, CA 94305 USA.
[5]Shanghai Univ TCM, Inst Liver Dis, Shuguang Hosp, Dept Cirrhosis, Shanghai, Peoples R China.
[6]Yale Univ, Dept Med, Med Ctr, New Haven, CT 06520 USA.
[7]Univ Calif San Diego, Med Ctr, Dept Med, San Diego, CA 92103 USA.
[8]Palo Alto Med Fdn, Dept Gastroenterol, Palo Alto, CA USA.
[9]Chinese Hosp, Dept Outpatient Clin, San Francisco, CA USA.
[10]San Jose Gastroenterol, San Jose, CA USA.
(8.0+极速模式)