Estimation of lead-time bias and its impact on the outcome of surveillance for the early diagnosis of hepatocellular carcinoma

Alessandro Cucchetti, Franco Trevisani, Anna Pecorelli, Virginia Erroi, Fabio Farinati, Francesca Ciccarese, Gian Lodovico Rapaccini, Mariella Di Marco, Eugenio Caturelli, Edoardo G. Giannini, Marco Zoli, Franco Borzio, Giuseppe Cabibbo, Martina Felder, Antonio Gasbarrini, Rodolfo Sacco, Francesco Giuseppe Foschi, Gabriele Missale, Filomena Morisco, Gianluca Svegliati BaroniRoberto Virdone, Mauro Bernardi, Antonio D. Pinna

Research output: Contribution to journalArticlepeer-review


Background & Aims Lead-time is the time by which diagnosis is anticipated by screening/surveillance with respect to the symptomatic detection of a disease. Any screening program, including surveillance for hepatocellular carcinoma (HCC), is subject to lead-time bias. Data regarding lead-time for HCC are lacking. Aims of the present study were to calculate lead-time and to assess its impact on the benefit obtainable from the surveillance of cirrhotic patients. Methods One-thousand three-hundred and eighty Child-Pugh class A/B patients from the ITA.LI.CA database, in whom HCC was detected during semiannual surveillance (n = 850), annual surveillance (n = 234) or when patients came when symptomatic (n = 296), were selected. Lead-time was estimated by means of appropriate formulas and Monte Carlo simulation, including 1000 patients for each arm. Results The 5-year overall survival after HCC diagnosis was 32.7% in semiannually surveilled patients, 25.2% in annually surveilled patients, and 12.2% in symptomatic patients (p

Original languageEnglish
Pages (from-to)333-341
Number of pages9
JournalJournal of Hepatology
Issue number2
Publication statusPublished - 2014


  • Cirrhosis
  • Hepatocellular carcinoma
  • Lead-time bias
  • Surveillance

ASJC Scopus subject areas

  • Hepatology
  • Medicine(all)


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