Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C. (9th March 2022)

• Record Type: Journal Article
• Authors: Perumalswami, Ponni V.; Wyatt, Brooke; Bowman, Chip A.; Patel, Krupa; Mageras, Anna; Lewis, Sara C.; Branch, Andrea D.
• Is Part Of: Cancer medicine. Volume 11:Number 9(2022)
• Page Start: 1995
• Page End: 2005
• Publication Date: 2022-03-09
• Subjects: African American -- direct acting antiviral -- hepatitis C -- hepatocellular carcinoma -- LI‐RADS -- sustained virological response; 616.994005
• DOI: 10.1002/cam4.4508
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Background: Hepatocellular carcinoma (HCC) incidence and mortality vary by race/ethnicity and both are higher in Black patients than in Whites. For HCC surveillance, all cirrhotic patients are advised to undergo lifelong twice‐annual abdominal imaging. We investigated factors associated with surveillance and HCC incidence in a diverse HCC risk group, cirrhotic patients recently cured of hepatitis C virus (HCV) infection. Methods: In this observational cohort study, all participants ( n = 357) had advanced fibrosis/cirrhosis and were cured of HCV with antiviral treatment. None had Liver Imaging Reporting and Data System (LI‐RADS) 2–5 lesions prior to HCV cure. Ultrasound, computed tomography, and/or magnetic resonance imaging were used for surveillance. Results: At a median follow‐up of 40 months [interquartile range (IQR) = 28–48], the median percentage of time up‐to‐date with surveillance was 49% (IQR) = 30%–71%. The likelihood of receiving a first surveillance examination was not significantly associated with race/ethnicity, but was higher for patients with more advanced cirrhosis, for example, bilirubin [odds ratio (OR) = 3.8/mg/dL, p = 0.002], private insurance (OR = 3.4, p = 0.006), and women (OR = 2.3, p = 0.008). The likelihood of receiving two or three examinations was significantly lower for non‐Hispanic Blacks and Hispanics versus non‐Hispanic Whites (OR = 0.39, and OR = 0.40, respectively, p < 0.005 for both) and for patients with higher platelet counts (OR = 0.99/10, 000 cells/µl, p = 0.01), but higher for patients with private insurance (OR = 2.8, p < 0.001). Incident HCC was associated with higher bilirubin (OR = 1.7, p = 0.02) and lower lymphocyte counts (OR = 0.16, p = 0.01). Conclusions: Contrary to best practices, HCC surveillance was associated with sociodemographic factors (insurance status and race/ethnicity) among patients cured of HCV. Guideline‐concordant surveillance is needed to address healthcare disparities. Abstract : Many hepatocellular carcinomas (HCCs) detected in patients cured of hepatitis C virus infection were present prior to cure, but did not have the characteristic imaging features needed for HCC diagnosis. Patients with worrisome imaging findings need to be excluded from measurement of HCC monitoring rates because of their potential for bias. Among patients with no worrisome imaging findings, Black and Hispanic patients were less likely to receive serial HCC surveillance than White patients, highlighting the need to reduce barriers to HCC surveillance among members of minority populations.