Early detection of liver cancer among patients with cirrhosis and MASLD

About This Grant

Abstract Hepatocellular carcinoma (HCC) is the most common type of liver cancer and is projected to be the third leading cause of cancer-related death by 2035. HCC surveillance, defined as screening high risk individuals with abdominal ultrasound every 6 months, is associated with earlier detection, increased curative treatment receipt, and improved overall survival. National data demonstrate that only 25% of patients with cirrhosis receive adequate HCC surveillance and little progress to increase uptake has been made over the past decade. While the current clinical practice paradigm for HCC surveillance focuses on high risk patients with cirrhosis, the rapid increase in the prevalence of metabolic dysfunction associated steatotic liver disease (MASLD) will lead to a larger population at risk for HCC for whom the net benefits of further risk stratification and HCC surveillance are unknown. Given changes in chronic liver disease etiology and HCC epidemiology, emerging novel risk-stratification and surveillance tools, and the initiation of the first multisite trial of HCC surveillance in the United States, there is a need for research to better understand HCC surveillance practices to determine optimal care among patients at risk for HCC development. The long-term goal is to improve healthcare delivery and outcomes for patients at risk for HCC by creating a population-based surveillance registry that will facilitate the implementation of targeted interventions to improve risk-stratification and appropriate healthcare delivery of HCC surveillance. The objective of this application is to establish the feasibility of developing a population-based HCC surveillance registry and assessing our ability to identify at risk patients with MASLD. These objectives will be accomplished through the following specific aims: 1) Develop and implement the tools required to establish a population-based HCC surveillance registry; and 2) Determine the prevalence of MASLD and the performance of ICD codes, lab results, and radiology imaging reports to identify MASLD. The study is conceptually innovative as it is centered on the paradigm shift driven by changes in liver disease etiology that will significantly impact the risk of developing HCC and thus the benefits and harms of HCC surveillance. The proposed research is significant because it will lay the foundation for future research to identify gaps in HCC surveillance and opportunities for improvement. Novel frameworks and approaches are needed to evaluate the impact of the rapid changes in the epidemiology of liver disease etiologies on HCC risk, surveillance, and outcomes.