Comparative Effectiveness of Surveillance and Current Treatment Approaches for the Detection and Management of Hepatocellular Carcinoma in East Asia Public Deposited

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  • March 19, 2019
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  • Chirovsky, Diana
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • Treatment approaches for hepatocellular carcinoma (HCC) in China are distinct in the use of resection with more advanced HCC, and continued research is needed to re-evaluate the appropriateness of guideline recommendations. Surveillance is recommended among individuals with chronic hepatitis B virus (HBV) infection in East Asia to improve early disease detection; however, only limited evidence exists to quantify its survival impact, and the ideal screening interval is not known. The overall objectives of this dissertation were to (1) compare the effectiveness of HCC treatment approaches in China, (2) evaluate the impact of 6-month and 12-month screening intervals compared with no surveillance among individuals with chronic HBV in China, and (3) examine the survival Impact of surveillance among HCC patients in Taiwan. This dissertation used clinical data extracted from medical records for HCC patients in China and Taiwan, as part of the global BRIDGE to Better Outcomes in HCC (HCC BRIDGE) Study. Multivariate Cox proportional hazard models compared survival with treatment in China, stratified by disease stage, and propensity score (PS) analysis was conducted to address selection bias. An individual-based simulation model combined well-established data on chronic HBV progression and tumor growth in HCC with clinical data from the HCC BRIDGE study in China to project the survival impact of different surveillance strategies. Using the HCC BRIDGE study in Taiwan, survival according to surveillance status was assessed using the Kaplan-Meier method, controlling for selection bias through PS analysis and lead time bias using a range of tumor volume doubling time (DT) estimated across tumor growth studies. The results revealed that patients with intermediate to advanced disease tolerate resection, and have better outcomes than with other HCC therapies. Surveillance improves survival with HCC, after applying lead time adjustments using a plausible range in DT. Results of model simulation suggest that surveillance performed at 12-month versus 6-month intervals can be more easily implemented with little impact on survival with HCC. These findings help inform efforts to ensure that individuals with chronic HBV are properly monitored for HCC given limited resources, and HCC patients receive appropriate treatment to improve survival outcomes in East Asia.
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  • In Copyright
Advisor
  • Wheeler, Stephanie
  • Orsini, Lucinda
  • Biddle, Andrea K.
  • Hassmiller Lich, Kristen
  • Barritt, A. Sidney
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2014
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  • Chapel Hill, NC
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  • This item is restricted from public view for 1 year after publication.
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