Introduction
The COVID-19 pandemic negatively affected cancer patients’ care in many ways, including the timely diagnosis of malignancies.1,2 Hepatocellular carcinoma is a tumor with well-defined risk factors that is potentially curable if detected in the early phase. Biannual ultrasound in high-risk patients has proven to be a valuable tool for accomplishing this goal and has therefore long been recommended.3 However, in Western countries, the reported adherence to surveillance protocols was low in pre-pandemic years.4 Since the declaration of the pandemic, primarily during the lockdown, but also in the post-lockdown period, many patients missed their regular check-ups, and physicians feared a further fall in surveillance adherence and a rise in the proportion of patients presenting with advanced disease.
Aims & Methods
The aim of this study was to assess whether the pandemic influenced the hepatocellular carcinoma (HCC) surveillance program. 350 patients (80.9% male, median age 66.9 years) treated at our Department between October 2010 and February 2023 due to newly diagnosed HCC were included in the analysis. The ongoing COVID-19 pandemic was declared in March 2020. Patients were divided into groups according to the time of HCC diagnosis (pre-pandemic and during the pandemic) and into surveillance and non-surveillance groups. Chi-square test was used to analyze the results. The level of statistical significance was set at p < 0.05.
Results
The number of newly diagnosed HCC cases was 28.4/year pre-pandemic and 27.7/year during the pandemic. There was no statistically significant difference between surveillance rates pre-pandemic (21.8%) and during the pandemic period (27.0%, P=0.385), nor in the proportion of patients that presented with symptomatic disease (P=0.314). During the pandemic, patients were more likely to be diagnosed in the potentially curative stage of the disease (BCLC 0 and BCLC A) (20.9% vs. 36.1%; OR 2.13, 95% CI:1.25-3.65; P=0.005).
Conclusion
Surprisingly, the pandemic did not influence HCC surveillance rates. Moreover, in this period, patients were more likely to be diagnosed in the potentially curative stage of the disease. Even though the benefits of HCC surveillance are well known and its implementation widely encouraged, the rates have been stably low over the last decade.
References
- Englum BR, Prasad NK, Lake RE, Mayorga-Carlin M, Turner DJ, Siddiqui T et al. Impact of the COVID-19 pandemic on diagnosis of new cancers: A national multicenter study of the Veterans Affairs Healthcare System. Cancer. 2022 Mar 1;128(5):1048-1056.
- Angelini M, Teglia F, Astolfi L, Casolari G, Boffetta P. Decrease of cancer diagnosis during COVID-19 pandemic: a systematic review and meta-analysis. Eur J Epidemiol. 2023 Jan;38(1):31-38.
- European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018 Jul;69(1):182-236.
- Singal AG, Lampertico P, Nahon P. Epidemiology and surveillance for hepatocellular carcinoma: New trends. J Hepatol. 2020;72(2):250-261.
Disclosure
Authors have no conflict of interest to declare.