Background Patients affected by HCC represent a vulnerable population during the COVID-19 pandemic and may suffer from the unusual allocation of healthcare resources. The aim of this study was to determine the impact of the COVID-19 pandemic on the management of HCC patients within six French referral centers of the metropolitan area of Paris. Materials and methods We performed a multicenter, retrospective, cross-sectional study on the management of patients affected by HCC during the first six weeks of COVID-19 pandemic (exposed), compared to the same period in 2019 (unexposed). Were included all patients discussed in multidisciplinary tumor meeting (MTB) and/or undergoing radiological or surgical programmed procedure during the study period, in a curative or palliative intent. Endpoints were the number of patients with a modification in the treatment strategy, or a delay in decision-to-treatment. Results After screening, n=670 patients were included (n=293 Exposed to COVID, n=377 Unexposed to COVID). A decrease of the numbers of patients with HCC presented in MTB in 2020 (p=0.034) and with a first diagnosis of HCC (n=104 Exposed to COVID, n=143 Unexposed to COVID, p=0.083) was find. Modification in the treatment strategy was observed in 13.1% of patients, with no differences between the two periods. Nevertheless 21.5% versus 9.5% of patients experienced a treatment delay longer than 1 month in 2020 compared to 2019 (p<0.001). In 2020, 7.1% (21/293) of patients had a diagnosis of an active COVID-19 infection: 11 (52.4%) were hospitalized, and 4 (19.1%) died. Conclusions In a metropolitan area highly impacted by COVID-19 pandemic, we observed a decreased number of cases of HCC, and similar rates of modification in treatment strategy, but with a treatment delay significantly longer in 2020 versus 2019.

BACKGROUND The coronavirus 2019 (COVID-19) pandemic has posed unprecedented challenges to healthcare systems and it may have heavily impacted patients with liver cancer (LC). This project has evaluated if the schedule of LC screening or procedures has been interrupted /delayed because of the COVID-19 pandemic. MATERIAL AND METHODS An international survey evaluated the impact of COVID-19 pandemic on clinical practice and clinical trials from March 2020 to June 2020, as the first phase of a multicentre, international and observational project. The focus was on patients with hepatocellular carcinoma or intrahepatic cholangiocarcinoma, cared for around the world during the first COVID-19 pandemic wave. RESULTS Ninety-one centres expressed interest to participate and 76 were included in the analysis, from Europe, South America, North America, Asia and Africa (73.7%, 17.1%, 5.3%, 2.6% and 1.3% per continent, respectively). Eighty-seven per cent of the centres modified their clinical practice: 40.8% the diagnostic procedures, 80.9% the screening program, 50% cancelled curative and/or palliative treatments for LC, and 44.0% cancelled the liver transplantation program. Forty-five out 69 (65.2%) centres in which clinical trials were running modified their treatments in that setting, but 58.1% were able to recruit new patients. The phone call service was modified in 51.4% of centres which had this service prior to COVID-19 pandemic (n=19/37). CONCLUSION The first wave of the COVID-19 pandemic had a tremendous impact on the routine care of patients with LC. Modifications in screening, diagnostic and treatment algorithms may have significantly impaired the outcome of patients. Ongoing data collection and future analyses will report the benefits and disadvantages of the strategies implemented, aiding future decision making.