Barriers to Surveillance for Hepatocellular Carcinoma in a Multicenter Cohort

• DOI: 10.1001/jamanetworkopen.2022.23504
• Publication Date: 2022-07-22T15:01:17Z
• Authors: Neehar D. Parikh; Nabihah Tayob; Taim Al-Jarrah; Jennifer Kramer; Jennifer Melcher; Donna Smith; Patrick Marquardt; Po-Hong Liu; Runlong Tang; Fasiha Kanwal; Amit G. Singal
• Keywords: Liver Cirrhosis; Male; 0301 basic medicine; Carcinoma, Hepatocellular; Liver Neoplasms; Middle Aged; 3. Good health; Cohort Studies; 03 medical and health sciences; Humans; Female; Original Investigation; Retrospective Studies

<h3>Importance</h3> Hepatocellular carcinoma (HCC) surveillance is underused in clinical practice, which may be owing to patient and clinician barriers. <h3>Objective</h3> To characterize HCC barriers associations with outcomes a multicenter cohort of patients cirrhosis. <h3>Design, Setting, Participants</h3> This retrospective, study included 5 medical centers the United States. Patients cirrhosis newly diagnosed treated from 2014 2018 were included. Data analyzed June 2021 February 2022. <h3>Exposure</h3> Surveillance completion 36-month period prior diagnosis. <h3>Main Outcomes Measures</h3> receipt was classified as semiannual, annual, or no surveillance. Multivariable logistic regression analysis used identify factors associated semiannual We conducted multivariable Cox analyses between curative treatment overall survival. <h3>Results</h3> A total 629 eligible (median [IQR] age, 63.6 [56.2-71.0] years; 491 [78.1%] men) assessed, including 7 American Indian Alaska Native (1.1%), 14 Asian (2.2), 176 Black (28.0%), 86 Hispanic (13.1%), 340 White (54.1%). Nearly two-thirds had diagnosis (mean [range by site] 63.7% [37.9%-80.4%]), mean (range site) 14.0% (5.3%-33.3%) having received 22.3% (14.3%-28.8%) annual The most common reasons for lack orders nonadherence site], 82.4% [66.7%-92.4%], although 17.6% (10.2%-22.1%) unrecognized at presentation. Semiannual hepatitis B infection (odds ratio [OR], 3.06 [95% CI, 1.24-7.23]) inversely race (OR, 0.41 0.20-0.80]) recognition 0.14 0.02-0.46]). significantly 2.73 1.60-4.70]) but not survival (HR, 0.81 0.55-1.18]). <h3>Conclusions Relevance</h3> In this cirrhosis, more than 80% failures across screening process. Dedicated programs improve detection attainment are needed.