Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C
Abstract Background Hepatocellular carcinoma (HCC) incidence and mortality vary by race/ethnicity and both are higher in Black patients than in Whites. For HCC surveillance, all cirrhotic patients are advised to undergo lifelong twice‐annual abdominal imaging. We investigated factors associated with...
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| Format: | Article |
| Language: | English |
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Wiley
2022-05-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.4508 |
| _version_ | 1828826676985856000 |
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| author | Ponni V. Perumalswami Brooke Wyatt Chip A. Bowman Krupa Patel Anna Mageras Sara C. Lewis Andrea D. Branch |
| author_facet | Ponni V. Perumalswami Brooke Wyatt Chip A. Bowman Krupa Patel Anna Mageras Sara C. Lewis Andrea D. Branch |
| author_sort | Ponni V. Perumalswami |
| collection | DOAJ |
| description | Abstract Background Hepatocellular carcinoma (HCC) incidence and mortality vary by race/ethnicity and both are higher in Black patients than in Whites. For HCC surveillance, all cirrhotic patients are advised to undergo lifelong twice‐annual abdominal imaging. We investigated factors associated with surveillance and HCC incidence in a diverse HCC risk group, cirrhotic patients recently cured of hepatitis C virus (HCV) infection. Methods In this observational cohort study, all participants (n = 357) had advanced fibrosis/cirrhosis and were cured of HCV with antiviral treatment. None had Liver Imaging Reporting and Data System (LI‐RADS) 2–5 lesions prior to HCV cure. Ultrasound, computed tomography, and/or magnetic resonance imaging were used for surveillance. Results At a median follow‐up of 40 months [interquartile range (IQR) = 28–48], the median percentage of time up‐to‐date with surveillance was 49% (IQR) = 30%–71%. The likelihood of receiving a first surveillance examination was not significantly associated with race/ethnicity, but was higher for patients with more advanced cirrhosis, for example, bilirubin [odds ratio (OR) = 3.8/mg/dL, p = 0.002], private insurance (OR = 3.4, p = 0.006), and women (OR = 2.3, p = 0.008). The likelihood of receiving two or three examinations was significantly lower for non‐Hispanic Blacks and Hispanics versus non‐Hispanic Whites (OR = 0.39, and OR = 0.40, respectively, p < 0.005 for both) and for patients with higher platelet counts (OR = 0.99/10,000 cells/µl, p = 0.01), but higher for patients with private insurance (OR = 2.8, p < 0.001). Incident HCC was associated with higher bilirubin (OR = 1.7, p = 0.02) and lower lymphocyte counts (OR = 0.16, p = 0.01). Conclusions Contrary to best practices, HCC surveillance was associated with sociodemographic factors (insurance status and race/ethnicity) among patients cured of HCV. Guideline‐concordant surveillance is needed to address healthcare disparities. |
| first_indexed | 2024-12-12T14:44:00Z |
| format | Article |
| id | doaj.art-0863558d68664f3a9dabb19d0848a245 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-12-12T14:44:00Z |
| publishDate | 2022-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-0863558d68664f3a9dabb19d0848a2452022-12-22T00:21:09ZengWileyCancer Medicine2045-76342022-05-011191995200510.1002/cam4.4508Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis CPonni V. Perumalswami0Brooke Wyatt1Chip A. Bowman2Krupa Patel3Anna Mageras4Sara C. Lewis5Andrea D. Branch6Division of Liver Diseases Icahn School of Medicine at Mount Sinai New York New York USADivision of Liver Diseases Icahn School of Medicine at Mount Sinai New York New York USADivision of Hospital Medicine Icahn School of Medicine at Mount Sinai New York New York USADivision of Hospital Medicine Icahn School of Medicine at Mount Sinai New York New York USADivision of Liver Diseases Icahn School of Medicine at Mount Sinai New York New York USADepartment of Radiology Icahn School of Medicine at Mount Sinai New York New York USADivision of Liver Diseases Icahn School of Medicine at Mount Sinai New York New York USAAbstract Background Hepatocellular carcinoma (HCC) incidence and mortality vary by race/ethnicity and both are higher in Black patients than in Whites. For HCC surveillance, all cirrhotic patients are advised to undergo lifelong twice‐annual abdominal imaging. We investigated factors associated with surveillance and HCC incidence in a diverse HCC risk group, cirrhotic patients recently cured of hepatitis C virus (HCV) infection. Methods In this observational cohort study, all participants (n = 357) had advanced fibrosis/cirrhosis and were cured of HCV with antiviral treatment. None had Liver Imaging Reporting and Data System (LI‐RADS) 2–5 lesions prior to HCV cure. Ultrasound, computed tomography, and/or magnetic resonance imaging were used for surveillance. Results At a median follow‐up of 40 months [interquartile range (IQR) = 28–48], the median percentage of time up‐to‐date with surveillance was 49% (IQR) = 30%–71%. The likelihood of receiving a first surveillance examination was not significantly associated with race/ethnicity, but was higher for patients with more advanced cirrhosis, for example, bilirubin [odds ratio (OR) = 3.8/mg/dL, p = 0.002], private insurance (OR = 3.4, p = 0.006), and women (OR = 2.3, p = 0.008). The likelihood of receiving two or three examinations was significantly lower for non‐Hispanic Blacks and Hispanics versus non‐Hispanic Whites (OR = 0.39, and OR = 0.40, respectively, p < 0.005 for both) and for patients with higher platelet counts (OR = 0.99/10,000 cells/µl, p = 0.01), but higher for patients with private insurance (OR = 2.8, p < 0.001). Incident HCC was associated with higher bilirubin (OR = 1.7, p = 0.02) and lower lymphocyte counts (OR = 0.16, p = 0.01). Conclusions Contrary to best practices, HCC surveillance was associated with sociodemographic factors (insurance status and race/ethnicity) among patients cured of HCV. Guideline‐concordant surveillance is needed to address healthcare disparities.https://doi.org/10.1002/cam4.4508African Americandirect acting antiviralhepatitis Chepatocellular carcinomaLI‐RADSsustained virological response |
| spellingShingle | Ponni V. Perumalswami Brooke Wyatt Chip A. Bowman Krupa Patel Anna Mageras Sara C. Lewis Andrea D. Branch Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C Cancer Medicine African American direct acting antiviral hepatitis C hepatocellular carcinoma LI‐RADS sustained virological response |
| title | Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C |
| title_full | Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C |
| title_fullStr | Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C |
| title_full_unstemmed | Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C |
| title_short | Hepatocellular carcinoma surveillance, incidence, and tumor doubling times in patients cured of hepatitis C |
| title_sort | hepatocellular carcinoma surveillance incidence and tumor doubling times in patients cured of hepatitis c |
| topic | African American direct acting antiviral hepatitis C hepatocellular carcinoma LI‐RADS sustained virological response |
| url | https://doi.org/10.1002/cam4.4508 |
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