P19 Factors associated with HCC stage at presentation and survival in a UK population. (20th September 2022)

• Record Type: Journal Article
• Authors: Spiers, Jessica; Li, Wenhao; Srivastava, Ankur; Caddick, Katharine; Hussain, Yaqza; Bannaga, Ayman; Muhammad, Saad; Tahir, Muhammad Nauman; Unitt, Esther; Than, Nwe Ni; Aravinthan, Aloysious; Sheth, Abhishek; Subhani, Mohsan; Alazawi, William
• Is Part Of: Gut. Volume 71(2022)Supplement 3
• Page Start: A44
• Page End: A45
• Publication Date: 2022-09-20
• Subjects: Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2022-BASL.70
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Background and Aims: Risk factors for hepatocellular carcinoma (HCC) include cirrhosis and diabetes, but patient- and disease-related factors in prognosis have not been widely explored. Evidence highlights ethnic disparity in HCC stage at presentation and survival in the USA, but there is little evidence evaluating any disparity in the UK. We sought to evaluate the factors associated with HCC stage at presentation and survival in a UK population. Method: We retrospectively analysed data from referrals to HCC multidisciplinary teams in 4 regional centres: East London and Essex, Nottingham, Coventry, and Bristol, between 2007 to 2021. Early-stage at presentation was defined as Barcelona Clinic Liver Centre (BCLC) Stages 0 and A, late-stage was defined as BCLC Stages C and D. Analyses were conducted using Cox regression models for survival and logistic regression models for stage at presentation, all adjusted for age, sex, aetiology of liver disease, HCC surveillance and centre. Results: We included 1357 patients with a median follow-up of 12 months. 31% of patients had Non-Alcoholic Fatty Liver Disease (NAFLD), 33% had Viral hepatitis, and 18% had Alcoholic Liver Disease (ALD). The overall 2-year survival rate was 40%. White ethnicity was independently associated with reduced mortality (Hazard ratio [HR] 0.835, p=0.043), but not early-stage presentation (Odds ratio [OR] 1.324, p=0.089). 21% of patients had non-cirrhotic HCC. Patients with NAFLD were more likely to develop non-cirrhotic HCC compared with patients with Viral hepatitis and ALD (24% vs. 10%, p<0.001 Chi-square). While HCC surveillance was associated with overall lower risk of mortality (HR 0.699, p<0.001), it was not associated with mortality in the 433 patients with NAFLD (HR 0.806, p=0.183). In patients with diabetes, metformin use was independently associated with early-stage presentation (OR 1.932, p=0.008) and survival (HR 0.674, p=0.008). Diabetes diagnosis was not associated with risk of death (HR 0.912, p=0.304). Conclusion: In this multi-centre study, White patients were less likely to die following a diagnosis of HCC compared to other ethnicities. Diabetes status was not an independent predictor of survival but, among patients with diabetes, those on metformin were almost twice as likely to present with early-stage disease, and were less likely to die, consistent with existing evidence for a protective role of metformin in HCC. HCC surveillance was a predictor of overall survival but not in patients with NAFLD who are at greater risk of developing non-cirrhotic HCC and for whom the current outpatient surveillance programme may require modification.