Did the Pandemic Affect HCC Surveillance?

Researchers affiliated with Liver Associates of Texas in Houston found that more than three-fourths of patients with cirrhosis or chronic hepatitis B infection (CHB) who had previously undergone recommended surveillance for hepatocellular carcinoma (HCC) failed to continue surveillance during 2020—and even more dropped out during 2021.

The reason even more patients failed to continue surveillance after lockdowns were lifted remains unknown, according to Stephanie Paduano, MD, who presented the poster on behalf of her colleagues as The Liver Meeting in Washington, DC.

The objective of this study was to determine what if any changes in HCC surveillance occurred during and after the COVID-19 pandemic. A secondary aim was to identify factors that might influence HCC surveillance.

Paduano and her colleagues conducted a retrospective study between January 2019 and December 2021 of patients diagnosed with CHB or cirrhosis. Patients who had either 2 liver ultrasounds, 1 abdominal CT, or 1 MRI in a year were considered to have completed HCC surveillance. HCC surveillance is recommended every 6 months for patients at high risk of developing HCC to enable early detection, which significantly improves prognosis.

The team performed a McNemar test to compare the surveillance completion before the pandemic (year 2019), during the lockdown phase (year 2020), and after lockdown (year 2021). Patient comorbidities were also recorded. Of 383 patients included in this study, the mean age was 58.4 years of age (± 12 years) and 60.1% were male.

The analysis revealed that 76.6% of patients who completed HCC surveillance in 2019 did not complete surveillance in 2021 (p<.001). Patients with more comorbidities were less likely to complete HCC surveillance by a ratio of 1.5 per additional comorbidity (p=0.015, OR: 1.5, CI: 1.85-4.58). Patients with diabetes mellitus and hypertension were less likely to complete HCC surveillance in 2021 compared with patients with only hyperlipidemia.

“There is still a downturn in HCC surveillance despite the reopening after the lockdown phase. Compared with 2019, HCC surveillance was down by 81.8% after the lockdown phase (year 2021),” Dr Paduano noted in the poster. “It is unclear why people are still not undergoing HCC surveillance despite the reopening after the lockdown phase of the COVID-19 pandemic.”

—Rebecca Mashaw
 

REFERENCE:
Paduano S, Avila D, Sanchez M, et al. Hepatocellular carcinoma (HCC) surveillance post-COVID-19: A new normal? Presented at: American Association for the Study of Liver Diseases —The Liver Meeting. November 5, 2022. Washington, DC.