Meta‐Analysis: Utilisation of Hepatocellular Carcinoma Surveillance

BACKGROUND AND AIMS: Major society guidelines recommend hepatocellular carcinoma (HCC) surveillance every 6 months with hepatic ultrasound. HCC surveillance is associated with early detection and improved survival but is underutilised. We aim to provide an updated assessment of HCC surveillance utilisation. METHODS: Ovid MEDLINE and Embase were searched from inception until 30 November 2023 to identify studies reporting the proportion of people with either cirrhosis or chronic hepatitis B who underwent ultrasound-based HCC surveillance. The primary objective was to determine the utilisation of HCC surveillance. A meta-analysis of proportions was conducted using a generalised linear mixed model. RESULTS: Forty-eight articles (1,275,349 individuals) met inclusion criteria. In at-risk individuals (cirrhosis or chronic hepatitis B), pooled utilisation of any HCC surveillance (n = 21 studies) was 54.45% (95% CI: 37.77-70.19), and utilisation of biannual surveillance (n = 7 studies) was 8.76% (95% CI: 2.46-26.79). Utilisation of any HCC surveillance was 53.37% (95% CI: 33.72-72.03) in patients with cirrhosis (n = 15 studies) and 66.43% (95% CI: 42.74-83.99) in patients with chronic hepatitis B (n = 12 studies), while utilisation of biannual surveillance was 10.20% (95% CI: 1.92-39.71) and 12.96% (95% CI: 0.02-99.09) respectively. Utilisation of surveillance did not improve over time. Pooled analysis of 40,497 individuals diagnosed with HCC (n = 27 studies) determined that the proportion of patients who had undergone prior screening or been diagnosed by surveillance was 36.07% (95% CI: 28.30-44.63). CONCLUSIONS: Less than 10% of patients received the recommended biannual ultrasound scans for surveillance. These findings are concerning and call for greater awareness and collaboration between care providers and healthcare policymakers to improve surveillance utilisation.