Rates and Predictors of Undergoing Different Hepatocellular Carcinoma Screening Tests in Patients With Cirrhosis

Abstract

INTRODUCTION: We aimed to assess rates and predictors of hepatocellular carcinoma (HCC) screening among patients with cirrhosis. METHODS: We reviewed electronic health records of 11,361 patients with cirrhosis from 11 U.S. Veterans Health Administration facilities for receipt of HCC screening in the 6 months preceding October 1, 2019. RESULTS: Nearly half of the cohort (46%) received HCC screening over a 6-month period. Screening rates and modalities (ultrasound, computed tomography, magnetic resonance imaging, serum alpha fetoprotein) varied by facility. Screening was associated with race/ethnicity, body mass index ≥ 25, cirrhosis etiology, thrombocytopenia, Fibrosis-4 ≥ 3.25, and lower Model for End-Stage Liver Disease-Sodium. DISCUSSION: HCC screening rates varied by facility. Higher risk patients were more likely to receive screening.

The COVID-19 Pandemic Highlights Opportunities to Improve Hepatocellular Carcinoma Screening and Diagnosis in a National Health System

“…We compared the number of patients who underwent imaging considered adequate for HCC screening (ultrasound, contrast-enhanced computed tomography, or magnetic resonance imaging ± alpha fetoprotein [AFP]) or had a new HCC diagnosis (ICD10 22.0) between the periods. We performed additional analyses by annual HCC risk (<1.5% vs ≥1.5% vs unknown) estimated by a validated HCC risk calculator developed for Veterans (8,9), Model for End Stage Liver Disease-Sodium (MELD-Na) score (≥20 vs <20), Fibrosis-4 (FIB-4) score (≥3.25 vs <3.25), and platelet count (<150k vs ≥150k) (5). Because 84,133 patients were in both periods, overlapping samples χ 2 and t -tests and multivariable logistic regression with intragroup correlation, adjusting for covariates determined a priori (5), were used for statistical analysis (see Methods , Supplementary Digital Content 1 , http://links.lww.com/AJG/C400).…”

“…This quality improvement study was approved by the US Veterans Affairs (VA) healthcare system. We identified all veterans with cirrhosis receiving care at VA facilities using the cirrhosis dashboard (see Methods, Supplementary Digital Content 1, http://links.lww.com/ AJG/C400) (5)(6)(7). Electronic patient data were obtained for two 6month periods before and after the pandemic declaration on March 1, 2020: September 1, 2019-February 29, 2020 ("pre-COVID-19") and April 1, 2020-September 30, 2020 ("post-COVID-19").…”

Epidemiology and risk-stratification of NAFLD-associated HCC

“…Currently, only the standard-of-care HCC screening tests of abdominal ultrasonography and serum AFP are recommended. However, CT and MRI scans appear to be used for screening not infrequently despite not being recommended 61,62 . Also, multiple biomarker panels (including multiproteinbased and circulating tumor derived DNA-based ["liquid biopsy"] panels) as well as abbreviated MRI protocols and other imaging based protocols are being actively investigated as screening tests, which may provide legitimate opportunities for true precision-based screening for HCC in the near future.…”

Epidemiology of non-alcoholic fatty liver disease and hepatocellular carcinoma

“… 77 Detection of the phosphorylated form of STAT3 in hepatocytes and hepatic stellate cells correlated with the severe histologic features of NASH, including lobular inflammation, ballooning inflammation, and an advanced stage of fibrosis. 78 These hypervascularity and pro-inflammatory states promote tumour growth and progression of HCC which may involve the entire liver or predominantly one lobe of the liver. Although there may be a predominance of HCC in the right lobe of the liver in patients with NASH, more data are needed to confirm this assertion.…”