Grant Number:	1R01CA125487-01A1 Interpret this number
Primary Investigator:	El-Serag, Hashem
Organization:	Baylor College Of Medicine
Project Title:	Surveillance for Hepatocellular Carcinoma Among Hcv-Infected Veterans
Fiscal Year:	2007

DESCRIPTION (provided by applicant): The incidence of hepatocellular carcioma (HCC) has doubled in the United States over the past two decades. Hepatitis C is the major risk factor for HCC with approximately 3 million individuals currently infected nationwide. Survival following HCC diagnosis is dismal except where potentially curative therapy (resection, transplant, local ablation) is applied. HCC surveillance is aimed at applying abdominal ultrasound and serum alpha-fetoprotein for diagnosing HCC at an early stage when patients are most likely to be eligible for potentially curative therapy. One randomized controlled trial and several cohort studies have indicated that HCC surveillance is associated with significantly improved survival. Practice guidelines have recommended HCC surveillance for patients with hepatitis C at high risk of developing HCC. However, there is a paucity of data evaluating the extent of prevalence, patterns, and determinants of HCC surveillance. AIMS: (i) To examine the patterns (prevalence, type, and frequency) of utilization of HCC surveillance in veterans infected with hepatitis C; (2) To examine patient-, facility provider-, and physician provider- determinants of HCC surveillance among veterans infected with hepatitis C; and (3) To examine the effect of HCC surveillance on the receipt of HCC potentially curative therapy and survival among veterans infected with hepatitis C, and to identify surveillance strategies associated with best outcomes. METHODS: We propose to conduct i) a retrospective cohort study of more than 150,000 patients infected with hepatitis C and 39,000 high-risk patients identified from the Department of Veterans Affairs Hepatitis C Registry, 2) a survey of more than 128 provider facilities to supplement information in the registry, and 3) a survey of physician providers to assess their knowledge and attitudes towards HCC surveillance. Surveillance tests will be identified in the registry based on a previously developed algorithm using data from administrative files. Patient-, tumor-, and facility determinants of HCC surveillance will be identifed from the Hepatitis C Registry and supplemented by the facility survey. Additionally, we will examine the association between surveillance and receipt of resection, transplant, or local ablation as well as survival. Hierarchical multivariable logistic regression and Cox proportional hazards modeling will be used to examine these outcomes. IMPACT: This study will examine a previously unaddressed subject pertaining to a highly fatal cancer that thus far has received little attention. It will provide information on the effectiveness of HCC screening as reflected by the extent of use as well as outcomes. Evaluating the extent and patterns of HCC surveillance is crucial in understanding diffusion (and obstacles) of this practice and in designing interventions to improve the implementation of HCC surveillance.




Validation of the Updated Hepatocellular Carcinoma Early Detection Screening Algorithm in a Community-Based Cohort of Patients With Cirrhosis of Multiple Etiologies.
Authors: Tayob N. , Corley D.A. , Christie I. , Almers L. , Rahal A.K. , Richardson P. , White D.L. , Davila J. , Kanwal F. , El-Serag H.B. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2020-08-05 00:00:00.0; , .
EPub date: 2020-08-05 00:00:00.0.
PMID: 32768590
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Clinical outcomes of hepatitis B virus coinfection in a United States cohort of hepatitis C virus-infected patients.
Authors: Kruse R.L. , Kramer J.R. , Tyson G.L. , Duan Z. , Chen L. , El-Serag H.B. , Kanwal F. .
Source: Hepatology (baltimore, Md.), 2014 Dec; 60(6), p. 1871-8.
PMID: 25065513
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Secular trends in the incidence of cholangiocarcinoma in the USA and the impact of misclassification.
Authors: Tyson G.L. , Ilyas J.A. , Duan Z. , Green L.K. , Younes M. , El-Serag H.B. , Davila J.A. .
Source: Digestive Diseases And Sciences, 2014 Dec; 59(12), p. 3103-10.
PMID: 25204668
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Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go?
Authors: El-Serag H.B. , Kanwal F. .
Source: Hepatology (baltimore, Md.), 2014 Nov; 60(5), p. 1767-75.
PMID: 24839253
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A new laboratory-based algorithm to predict development of hepatocellular carcinoma in patients with hepatitis C and cirrhosis.
Authors: El-Serag H.B. , Kanwal F. , Davila J.A. , Kramer J. , Richardson P. .
Source: Gastroenterology, 2014 May; 146(5), p. 1249-55.e1.
PMID: 24462733
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Hepatocellular carcinoma screening practices in the Department of Veterans Affairs: findings from a national facility survey.
Authors: El-Serag H.B. , Alsarraj A. , Richardson P. , Davila J.A. , Kramer J.R. , Durfee J. , Kanwal F. .
Source: Digestive Diseases And Sciences, 2013 Nov; 58(11), p. 3117-26.
PMID: 23868438
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Prevalence and predictors of hepatitis B virus coinfection in a United States cohort of hepatitis C virus-infected patients.
Authors: Tyson G.L. , Kramer J.R. , Duan Z. , Davila J.A. , Richardson P.A. , El-Serag H.B. .
Source: Hepatology (baltimore, Md.), 2013 Aug; 58(2), p. 538-45.
PMID: 23505059
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Epidemiology of hepatocellular carcinoma: consider the population.
Authors: Mittal S. , El-Serag H.B. .
Source: Journal Of Clinical Gastroenterology, 2013 Jul; 47 Suppl, p. S2-6.
PMID: 23632345
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Determinants of serum alpha-fetoprotein levels in hepatitis C-infected patients.
Authors: Richardson P. , Duan Z. , Kramer J. , Davila J.A. , Tyson G.L. , El-Serag H.B. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2012 Apr; 10(4), p. 428-33.
PMID: 22155556
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Level of ¿-fetoprotein predicts mortality among patients with hepatitis C-related hepatocellular carcinoma.
Authors: Tyson G.L. , Duan Z. , Kramer J.R. , Davila J.A. , Richardson P.A. , El-Serag H.B. .
Source: Clinical Gastroenterology And Hepatology : The Official Clinical Practice Journal Of The American Gastroenterological Association, 2011 Nov; 9(11), p. 989-94.
PMID: 21820396
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Effectiveness of AFP and ultrasound tests on hepatocellular carcinoma mortality in HCV-infected patients in the USA.
Authors: El-Serag H.B. , Kramer J.R. , Chen G.J. , Duan Z. , Richardson P.A. , Davila J.A. .
Source: Gut, 2011 Jul; 60(7), p. 992-7.
PMID: 21257990
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Increasing prevalence of HCC and cirrhosis in patients with chronic hepatitis C virus infection.
Authors: Kanwal F. , Hoang T. , Kramer J.R. , Asch S.M. , Goetz M.B. , Zeringue A. , Richardson P. , El-Serag H.B. .
Source: Gastroenterology, 2011 Apr; 140(4), p. 1182-1188.e1.
PMID: 21184757
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Utilization of surveillance for hepatocellular carcinoma among hepatitis C virus-infected veterans in the United States.
Authors: Davila J.A. , Henderson L. , Kramer J.R. , Kanwal F. , Richardson P.A. , Duan Z. , El-Serag H.B. .
Source: Annals Of Internal Medicine, 2011-01-18 00:00:00.0; 154(2), p. 85-93.
PMID: 21242365
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Surveillance for hepatocellular carcinoma: development and validation of an algorithm to classify tests in administrative and laboratory data.
Authors: Richardson P. , Henderson L. , Davila J.A. , Kramer J.R. , Fitton C.P. , Chen G.J. , El-Serag H.B. .
Source: Digestive Diseases And Sciences, 2010 Nov; 55(11), p. 3241-51.
PMID: 20844957
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Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States.
Authors: Davila J.A. , Morgan R.O. , Richardson P.A. , Du X.L. , McGlynn K.A. , El-Serag H.B. .
Source: Hepatology (baltimore, Md.), 2010 Jul; 52(1), p. 132-41.
PMID: 20578139
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Risk of hepatobiliary and pancreatic cancers after hepatitis C virus infection: A population-based study of U.S. veterans.
Authors: El-Serag H.B. , Engels E.A. , Landgren O. , Chiao E. , Henderson L. , Amaratunge H.C. , Giordano T.P. .
Source: Hepatology (baltimore, Md.), 2009 Jan; 49(1), p. 116-23.
PMID: 19085911
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