Table 3. Association between different timing of ultrasonographic surveillance and the risk of mortality following hepatocellular carcinoma diagnosis among patients with viral hepatitis: Cox proportional-hazards regression models, with survival times uncorrected and corrected for lead time bias.

Screening	UnadjustedHR (95% CI)	P-value	Age-sex adjusted HR (95% CI)	P-value	Fully adjusted*HR (95% CI)	P-value	Fully adjusted † HR (95% CI)	P-value
Uncorrected for lead time bias
Routine surveillance	0.623 (0.523, 0.743)	<0.001	0.611 (0.512, 0.729)	<0.001	0.666 (0.555, 0.799)	<0.001	0.706 (0.589, 0.848)	<0.001
Inconsistent screening	0.819 (0.716, 0.936)	0.003	0.806 (0.704, 0.923)	0.002	0.833 (0.725, 0.956)	0.010	0.778 (0.677, 0.894)	<0.001
No screening	1.00 (referent)		1.00 (referent)		1.00 (referent)		1.00 (referent)
Corrected for lead time bias
Sojourn time = 42 days
Routine surveillance	0.655 (0.549, 0.781)	<0.001	0.642 (0.538, 0.766)	<0.001	0.692 (0.577, 0.830)	<0.001	0.740 (0.617, 0.887)	0.001
Inconsistent screening	0.862 (0.754, 0.986)	0.030	0.849 (0.742, 0.972)	0.018	0.877 (0.764, 1.008)	0.064	0.830 (0.722, 0.953)	0.008
No screening	1.00 (referent)		1.00 (referent)		1.00 (referent)		1.00 (referent)
Sojourn time = 70 days
Routine surveillance	0.672 (0.563, 0.801)	<0.001	0.659 (0.552, 0.786)	<0.001	0.711 (0.592, 0.852)	<0.001	0.762 (0.635, 0.914)	0.003
Inconsistent screening	0.886 (0.775, 1.012)	0.075	0.872 (0.762, 0.998)	0.047	0.902 (0.785, 1.036)	0.142	0.856 (0.745, 0.983)	0.028
No screening	1.00 (referent)		1.00 (referent)		1.00 (referent)		1.00 (referent)
Sojourn time = 121 days
Routine surveillance	0.699 (0.586, 0.833)	<0.001	0.686 (0.574, 0.818)	<0.001	0.741 (0.618, 0.888)	0.001	0.798 (0.665, 0.957)	0.015
Inconsistent screening	0.921 (0.805, 1.052)	0.226	0.907 (0.792, 1.038)	0.155	0.937 (0.816, 1.076)	0.357	0.895 (0.779, 1.029)	0.119
No screening	1.00 (referent)		1.00 (referent)		1.00 (referent)		1.00 (referent)
Sojourn time = 140 days
Routine surveillance	0.709 (0.595, 0.846)	<0.001	0.696 (0.583, 0.830)	<0.001	0.753 (0.628, 0.903)	0.002	0.812 (0.677, 0.974)	0.025
Inconsistent screening	0.935 (0.818, 1.069)	0.323	0.921 (0.804, 1.054)	0.230	0.951 (0.828, 1.093)	0.481	0.912 (0.794, 1.047)	0.191
No screening	1.00 (referent)		1.00 (referent)		1.00 (referent)		1.00 (referent)
Sojourn time = 180 days
Routine surveillance	0.727 (0.610, 0.866)	<0.001	0.713 (0.597, 0.851)	<0.001	0.773 (0.644, 0.927)	0.005	0.836 (0.697, 1.002)	0.053
Inconsistent screening	0.958 (0.838, 1.095)	0.528	0.943 (0.824, 1.08)	0.398	0.977 (0.850, 1.122)	0.740	0.938 (0.817, 1.078)	0.366
No screening	1.00 (referent)		1.00 (referent)		1.00 (referent)		1.00 (referent)
Sojourn time = 614 days
Routine surveillance	0.861 (0.722, 1.026)	0.095	0.846 (0.709, 1.009)	0.063	0.921 (0.768, 1.104)	0.373	1.002 (0.836, 1.202)	0.980
Inconsistent screening	1.134 (0.992, 1.297)	0.065	1.118 (0.977, 1.280)	0.105	1.161 (1.010, 1.334)	0.036	1.125 (0.979, 1.292)	0.098
No screening	1.00 (referent)		1.00 (referent)		1.00 (referent)		1.00 (referent)

*Adjusted for: age at HCC diagnosis; sex; rural residence; income quintile; Charlson-Deyo Comorbidity Index; diabetes diagnosis; indicators of severe liver disease: No alcoholic liver disease (ALD)+no cirrhosis; No ALD+Cirrhosis only; No ALD+Decompensated cirrhosis; ALD+No cirrhosis; ALD+Cirrhosis; ALD+Decompensated cirrhosis; Non-alcoholic fatty liver disease (NAFLD)+Cirrhosis; and index year of hepatocellular carcinoma (HCC) diagnosis.

^†All covariates, including receipt of HCC curative treatment (i.e., surgical resection, liver transplantation, or radiofrequency ablation). Variables modeled as time-dependent covariate include: Charlson-Deyo Comorbidity Index; diabetes diagnosis; and HCC curative treatment.