Very Early-Stage Detection Is Associated With Improved Survival in Patients With Unifocal Hepatocellular Carcinoma.
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BACKGROUND AND AIMS: The goal of hepatocellular carcinoma (HCC) surveillance is to improve early HCC detection; however, the incremental benefits of detection of T1a tumours compared to T1b tumours are unclear. We aimed to evaluate the survival of patients with HCC detected at a T1a stage compared to T1b stage. METHODS: We conducted a multicentre retrospective study of adult patients from three sites in the United States who were newly diagnosed with unifocal HCC (based on LIRADS v2018), measuring between 1.0 and 3.0 cm at diagnosis between July 2013 and November 2022. All patients were required to have Child-Turcotte-Pugh (CP) class A or B cirrhosis and undergo timely treatment within 90 days of diagnosis. Multivariable Cox proportional hazard models were used to evaluate associations between tumour size (T1a vs. T1b) and overall survival and transplant-free survival. RESULTS: Of 140 eligible patients (median age 67 years, 72% male), 88 had T1a and 52 had T1b HCC. Median overall survival was 5.5 (95% CI: 3.79-NE (Not Evaluable)) years for patients with T1a HCC versus 3.1 (95% CI: 2.52-4.63) years for those with T1b HCC (p = 0.019). In multivariable analysis, mortality was significantly associated with Child Pugh B (vs. Child Pugh A; HR: 2.362; 95% CI: 1.39-4.93), higher logarithm transformed AFP (HR: 1.42; 95% CI: 1.20-1.69) and lesion size in cm (HR: 2.95; 95% CI: 1.69-5.16). CONCLUSIONS: Detection of HCC at a T1a stage conveys a survival advantage compared to T1b stage, underscoring a continued need for improvements in HCC surveillance efficacy.