{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:50:29Z","timestamp":1790610629033,"version":"4.1.0"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Cohort studies demonstrating an association of hepatocellular carcinoma (HCC) screening with reduced mortality are prone to lead-time and length-time biases.<\/jats:p><\/jats:sec>Objective<\/jats:title>To characterize the clinical benefits of HCC screening, adjusting for lead-time and length-time biases, in a diverse, contemporary cohort of at-risk patients.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study of patients with HCC was conducted between January 2008 and December 2022 at 2 large US health systems. Data analysis was performed from September to November 2023.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was screen-detected HCC, defined by abnormal screening-intent abdominal imaging or \u03b1-fetoprotein level within 6 months before diagnosis. Cox regression analysis was used to characterize differences in overall survival between patients with screen-detected and non\u2013screen-detected HCC; lead-time and length-time adjustments were calculated using the Duffy parametric formula.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 1313 patients with HCC (mean [SD] age, 61.7 [9.6] years; 993 male [75.6%]; 739 [56.3%] with Barcelona Clinic Liver Cancer stage 0\/A disease), HCC was screen-detected in 556 (42.3%) and non\u2013screen detected in 757 (57.7%). Patients with screen-detected HCC had higher proportions of early-stage HCC (393 patients [70.7%] vs 346 patients [45.7%]; risk ratio [RR], 1.54; 95% CI, 1.41-1.70) and curative treatment receipt (283 patients [51.1%] vs 252 patients [33.5%]; RR, 1.52; 95% CI, 1.34-1.74) compared with patients with non\u2013screen-detected HCC. The screen-detected group had significantly lower mortality, which persisted after correcting for lead-time bias (hazard ratio, 0.75; 95% CI, 0.65-0.87) in fully adjusted models. Both groups had similar tumor doubling times (median [IQR], 3.8 [2.2-10.7] vs 5.6 [1.7-11.4] months) and proportions of indolent tumors (28 patients [35.4%] vs 24 patients [38.1%]; RR, 0.93; 95% CI, 0.60-1.43). Adjustment for length-time bias decreased survival estimates, although 3-year and 5-year survival for patients with screen-detected HCC remained longer than that for patients with non\u2013screen-detected HCC.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this cohort study suggest that HCC screening is associated with reduced mortality even after accounting for lead-time and length-time biases. However, these biases should be considered in future studies.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.8755","type":"journal-article","created":{"date-parts":[[2024,4,29]],"date-time":"2024-04-29T15:33:36Z","timestamp":1714404816000},"page":"e248755","source":"Crossref","is-referenced-by-count":31,"title":["Hepatocellular Carcinoma Screening in a Contemporary Cohort of At-Risk Patients"],"prefix":"10.1001","volume":"7","author":[{"given":"Darine","family":"Daher","sequence":"first","affiliation":[{"name":"Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Seif El Dahan","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole E.","family":"Rich","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabihah","family":"Tayob","sequence":"additional","affiliation":[{"name":"Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Merrill","sequence":"additional","affiliation":[{"name":"Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Q.","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju Dong","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Cedars Sinai Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand V.","family":"Kulkarni","sequence":"additional","affiliation":[{"name":"Department of Hepatology and Liver Transplantation, AIG Hospitals, Hyderabad India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fasiha","family":"Kanwal","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, Texas"},{"name":"Michael E. 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