Reply to "surveillance for hepatocellular carcinoma: A tale of two countries"

To the Editor:
We appreciate the interest of Dr. Farrell and Dr. Cross in our article. In this work, we retrospectively examined 1288 patients diagnosed with hepatocellular carcinoma (HCC) in the period 2005–2012 in five academic centers in the Netherlands. Surveillance was associated with smaller tumor size, lower alpha–fetoprotein (AFP) levels, earlier tumor stage and resection/transplantation or RFA more often applied, with significantly higher survival rates.
Although Dr. Farrell and Dr. Cross are enthusiastic, we would like to draw attention to the limitations of our article. Our retrospective analysis is inherently subject to potential bias. [...]