P77 Do clinicians adhere to local and national guidance hepatocellular carcinoma in chronic hepatitis B patients. An analysis of local practice. (20th September 2022)

• Record Type: Journal Article
• Authors: Sutherland, Katherine; Priest, Matthew; Fraser, Andrew; Cairns, Helen; Swann, Rachael
• Is Part Of: Gut. Volume 71(2022)Supplement 3
• Page Start: A90
• Page End: A90
• Publication Date: 2022-09-20
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BASL.128
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Introduction: Chronic hepatitis B is one of the main causes of hepatocellular carcinoma (HCC) worldwide, even in the absence of liver cirrhosis. Factors increasing this risk include Asian and African ethnicity, older age, advanced liver fibrosis and family history of HCC. As international guidelines differ on recommendations for surveillance, local consensus guidelines have been developed to identify those most at risk. We aimed to investigate adherence to these guidelines and identify any factors associated with over or under surveillance. We also compared those identified as needing surveillance in the guidelines, with those deemed most at risk by the REACH-B score. Methods: Patients attending HBV clinics over the past 8 years in our hospital were screened and included if they had a positive hepatitis B surface antigen for longer than 6 months. Clinical, pathological and viral features were recorded for each patient. Data was analysed using GraphPad Prism v8.4 to identify any associations between patient characteristics and under surveillance under local guidelines. A REACH-B score of 13 was used to identify patients at high risk of hepatocellular carcinoma (>1.5% risk a year) and comparison made to the surveillance population. Results: Data from 234 patients were collected. Date of last follow up varied from 2014 to 2022. 14 patients were excluded due to 1 patient clearing the infection and 13 being non-attenders after diagnosis. 56.6%(124) of patients were Asian ethnicity, 16%(35) Black ethnicity(15%(33) Black African) and 21.5%(47) white ethnicity. 12.8%(28) were >65 years old and 66.2%(145) male. 3.1%(6) had liver cirrhosis and 2.3%(5) were diagnosed with hepatocellular carcinoma during the follow up period. In total 157 patients (69.9%) met the criteria for HCC surveillance, 15 of these were not enrolled in a surveillance programme. There was a significant association with Black African ethnicity and under surveillance (p=0.026). No other associations with under surveillance were identified. Only 1 patient in our cohort had a REACH B score ≥13 with no association between a REACH B score ≥13 and under surveillance for hepatocellular carcinoma p=0.5288. Conclusions: Our data suggests those of Black African ethnicity are being under surveilled for hepatocellular carcinoma. This may be due to lack of awareness of increased risk in these individuals or due to recording of ethnicity on electronic records, further quality improvement work to rectify this is planned. The REACH B score did not provide any additional benefit in identifying patients for surveillance.