Yonsei Med J.  2021 Aug;62(8):758-766. 10.3349/ymj.2021.62.8.758.

Effectiveness of Hepatocellular Carcinoma Surveillance and an Optimal Surveillance Interval: Nationwide Cohort of Korea

  • 1Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
  • 2Big Data Strategy Department, National Health Insurance Service, Wonju, Korea
  • 3Departments of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
  • 4Department of Radiology, Yongin Severance Hospital, Yongin, Korea
  • 5Departments of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea


To assess associations between surveillance intervals in a national hepatocellular carcinoma (HCC) surveillance program and receiving curative treatment and mortality using nationwide cohort data for Korea.
Materials and Methods
Using the National Health Insurance Service Database of Korea, we retrospectively identified 3201852 patients, the target population of the national HCC surveillance program, between 2008 and 2017. After exclusion, a total of 64674 HCC patients were divided based on surveillance intervals: never screened, ≤6 months (6M), 7–12 months (1Y), 13–24 months (2Y), and 25–36 months (3Y). Associations for surveillance interval with the chance to receive curative therapy and all-cause mortality were analyzed.
The 6M group (51.9%) received curative therapy more often than the other groups (1Y, 48.3%; 2Y, 43.8%; 3Y, 41.3%; never screened, 34.5%). Odds ratio for receiving curative therapy among the other surveillance interval groups (1Y, 0.87; 2Y, 0.76; 3Y, 0.77; never screened, 0.57; p<0.001) were significantly lower than that of the 6M group. The hazard ratios (HRs) of all-cause mortality were 1.07, 1.14, and 1.37 for 2Y, 3Y, and never screened groups. The HR for the 1Y group (0.96; p=0.092) was not significantly different, and it was lower (0.91; p<0.001) than that of the 6M group after adjustment for lead-time bias. Curative therapy was associated with survival benefits (HR, 0.26; p<0.001).
HCC surveillance, especially at a surveillance interval of 6 months, increases the chance to receive curative therapy.


Hepatocellular carcinoma; surveillance; mortality
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