ORIGINAL RESEARCH article
Front. Oncol.
Sec. Cancer Epidemiology and Prevention
This article is part of the Research TopicEquity in Cancer Prevention and Early DetectionView all 7 articles
Three-year of hepatocellular carcinoma surveillance in patients with cirrhosis diagnosed between 2009 and 2013: a cohort study based on the French National Health Data System (SNDS) claims data
Provisionally accepted
Pascal Caillet1*
Fréderic Balusson2Nathalie Ganne-Carié3Emmanuel Oger2Charlotte Costentin4Olivier Ganry5- 1Centre Hospitalier Universitaire (CHU) de Nantes, Nantes, France
- 2Centre Hospitalier Universitaire de Rennes, Rennes, France
- 3Hopitaux Universitaires Paris-Seine-Saint-Denis, Bobigny, France
- 4Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
- 5Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
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Objectives: Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. Most cases occur in patients with an underlying cirrhosis. The French national guidelines recommend semiannual abdominal ultrasound surveillance for early HCC detection in patients with cirrhosis. The primary goal of our retrospective cohort study was to evaluate compliance with this recommendation. Methods: We used 2007–2016 general public health insurance program (Régime Général) data from the French National Health Data System (Système National des Données de Santé, or SNDS). Included patients were 18 to 75 years old, diagnosed with liver cirrhosis between 2009 and 2013, and underwent their first ultrasound >4 months after their index date. The number of annual ultrasounds was recorded over a 3-year follow-up period. Compliance was defined as having had at least 2 ultrasounds per year over the follow-up time. Results: Among the 66,464 patients included in the analysis, surveillance was optimal (no year with <2 ultrasounds) in 5,082 patients (7.6%), suboptimal (one year with <2 ultrasounds) in 3,928 (5.9%), and failed (remaining cases) in 57,454 (86.4%). Older age, male sex, a high Charlson Co-morbidity Index (CCI), frequent gastroenterologist/hepatologist visits, and viral etiology were associated with better surveillance, whereas low socioeconomic status, despite France's universal health coverage, was linked to failed surveillance. Discussion: In French patients with cirrhosis, most of cancer surveillance is failing. In order to improve surveillance, a better understanding of the social determinants of health equity is needed.
Keywords: cirrhosis, Hepatocellular carcinoma surveillance, cohort study, prevention, Ultrasound echo
Received: 10 Oct 2025; Accepted: 31 Oct 2025.
Copyright: © 2025 Caillet, Balusson, Ganne-Carié, Oger, Costentin and Ganry. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Pascal Caillet, pascal.caillet@chu-nantes.fr
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