Inadequate Hepatocellular Carcinoma Screening in Patients with Nonalcoholic Steatohepatitis Cirrhosis

Elizabeth Aby, Jennifer Phan, Emily Truong, Jonathan Grotts, Sammy Saab

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Background: Nonalcoholic steatohepatitis (NASH) is a common cause of liver disease which can progress to cirrhosis and hepatocellular carcinoma (HCC). American Association for the Study of Liver Diseases (AASLD) guidelines recommend abdominal ultrasound, with or without serum alpha-fetoprotein, every 6 months for HCC surveillance in cirrhotic patients. Goals: Describe HCC surveillance rates in NASH cirrhosis compared with hepatitis C (HCV) cirrhosis and the impact of surveillance on tumor size, treatment, and mortality. Study: Adults with NASH and HCV cirrhosis diagnosed with HCC from 2009 to 2016 were retrospectively evaluated. Patients were categorized into 3 mutually exclusive disease screening groups based on abdominal imaging with or without serum alpha-fetoprotein testing before HCC diagnosis. Results: In total, 99 patients with NASH cirrhosis and 162 patients with HCV cirrhosis were evaluated. In total, 51.5% of NASH cirrhosis patients and 25.9% of HCV cirrhosis patients had no screening before HCC diagnosis. Patients with HCV cirrhosis were significantly more likely to undergo surveillance compared with patients with NASH cirrhosis (P=0.002). NASH cirrhosis patients who underwent complete screening had smaller tumors compared with those with incomplete screening and no screening (P=0.006). There were no differences in number of tumors at diagnosis or mortality between screening groups in patients with NASH cirrhosis (P=0.281 and 0.468, respectively). Conclusions: There is suboptimal HCC surveillance in NASH and HCV cirrhotic patients, with a greater proportion of patients with NASH cirrhosis not undergoing surveillance. Patients with NASH cirrhosis who had complete surveillance had smaller tumors at diagnosis, but there were no differences in treatment outcomes or mortality.

Original languageEnglish (US)
Pages (from-to)142-146
Number of pages5
JournalJournal of clinical gastroenterology
Issue number2
StatePublished - Feb 1 2019

Bibliographical note

Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.


  • hepatocellular carcinoma
  • liver cancer
  • nonalcoholic fatty liver disease
  • surveillance


Dive into the research topics of 'Inadequate Hepatocellular Carcinoma Screening in Patients with Nonalcoholic Steatohepatitis Cirrhosis'. Together they form a unique fingerprint.

Cite this