Factors that Affect the Surveillance and Late-Stage Detection of a Newly Diagnosed Hepatocellular Carcinoma

Document Type : Research Articles


1 Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand.

2 Department of Internal Medicine, Hatyai Hospital, Songkhla, Thailand.


Background: Surveillance of hepatocellular carcinoma (HCC) is beneficial for detecting early-stage HCC. The factors that influence adherence to HCC surveillance and late-stage detection have never been evaluated. We investigated the predictive factors that contribute to patients accessing regular HCC surveillance and their association with the detection of late-stage HCC at the time of diagnosis. Methods: We conducted a prospective observational study at Hatyai Hospital (Songkhla, Thailand) between 2014 and 2016. HCC surveillance includes performing hepatic ultrasonography with/without serum alpha-fetoprotein 6–12 months before the detection of HCC. Logistic regression analyses were conducted separately to examine the relationship between the variables and each endpoint. Results: One hundred ninety-nine HCC patients were enrolled in the study; most patients were of low socioeconomic status, 90.5% had less than a bachelor’s degree, and 69.3% of patients had a monthly income of <10,000 baths (US $312.50). Nearly all (93.5%) patients had cirrhosis, 39.7% had hepatitis B virus (HBV) infection, 24.6% had hepatitis C virus infection, and 24.6% had alcohol-related liver disease. The risk of HCC was recognized in 51.8% of patients, and regular HCC surveillance was achieved in 36.2% of patients. Multivariate logistic regression analysis revealed that a monthly income >10,000 baths (US $312.50) (odds ratio [OR], 4.566; p = 0.013), HBV infection (OR, 0.188; p = 0.001), and recognition of patients at risk of HCC (OR, 130.396; p<0.001) were independent predictive factors for adherence to HCC surveillance. Regular HCC surveillance (OR, 0.215; p = 0.003) and recognition of HBV infection (OR, 0.356; p = 0.040) were independent preventive factors for the detection of late-stage HCC at the time of diagnosis. Conclusion: In Thailand, awareness of patients at risk of developing HCC and the rate of regular HCC surveillance are low. Greater awareness will enable physicians to surveil and detect HCC.


Main Subjects

Volume 22, Issue 10
October 2021
Pages 3293-3298
  • Receive Date: 24 June 2021
  • Revise Date: 29 July 2021
  • Accept Date: 13 October 2021
  • First Publish Date: 13 October 2021