Rates and Factors Associated With Hepatocellular Carcinoma Diagnosis, Stage, Treatment, and Survival
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background and Aims: Up-to-date information is needed on hepatocellular carcinoma (HCC) diagnosis, stage, treatment, and survival. Methods: Of > 2000 patients with a new diagnosis of HCC in 2023 in the US Veterans Health Administration, a random subsample of 194 confirmed HCC cases were selected for a structured medical record review by expert hepatologists. Results: Among 194 confirmed HCC cases in 2023, mean age was 73 years, and only 56.7% had cirrhosis diagnosed before HCC, while 12.9% had cirrhosis diagnosed after HCC and 22.2% did not have cirrhosis. Stage at diagnosis was T1 in 17.5%, T2 in 42.3%, and beyond T2 in 40.2%. Early-stage diagnosis (T1 or T2) was more common in the following groups: cirrhosis diagnosed before HCC (70.9%), HCC diagnosed by screening (86.3%), high performance status (73.0%), receipt of Veterans Affairs (VA) primary care (63.3%), or VA liver care (72.6%). Among 147 of 194 patients (75.8%) who received HCC-directed treatments, the most common, first-line treatment was Y-90 radioembolization (28.6%), followed by ablation (21.1%), transarterial chemoembolization (20.4%), systemic therapy (17.0%), surgical resection (7.5%), and external beam radiation (5.4%). Mortality (29.9% at 1 year, 44.8% at 2 years) was lower in those with early-stage diagnosis, diagnosis via screening, Child-Turcotte-Pugh class A, Model for End-Stage Liver Disease ≤ 10, absence of cirrhosis, cured hepatitis C virus, receipt of curative treatments, VA primary or liver care, and good performance status. Conclusion: These results highlight the importance of HCC screening and engagement in liver care for early HCC diagnosis, curative treatment, and improved survival while demonstrating the feasibility of a national quality improvement program for addressing persistent gaps in the HCC screening, diagnosis, and treatment.
Source: Gastro Hep Advances
Authors: George N. Ioannou, Vera Yakovchenko, Tamar Taddei, Alexander Monto, Heather Patton, Monica Merante, Patrick Spoutz, Linda Chia, Jennifer Yudkevich, Ayse Aytaman, Atoosa Rabiee, Binu John, Boris Blechacz, Cindy X. Cai, Hochong Gilles, Anand S. Shah, Heather McCurdy, Puneet Puri, Janice Jou, Khurram Mazhar, Cesar Taborda-Vidarte, Sujan Ravi, Alpna Limaye, Amar B. Mandalia, Karlyn Rupert, Jason A. Dominitz, Jennifer Anwar, Timothy R. Morgan, Shari S. Rogal
Institutions: University of Washington, VA Puget Sound Health Care System, VA Pittsburgh Healthcare System, Yale University, VA Connecticut Healthcare System, VA Greater Los Angeles Healthcare System, VA San Diego Healthcare System, VA Northwest Network, VA NY Harbor Healthcare System, State University of New York, SUNY Downstate Health Sciences University, Washington DC VA Medical Center, University of Miami, Miami VA Healthcare System, South Texas Veterans Health Care System, University of California, Riverside, Loma Linda University, VA Loma Linda Healthcare System, Emory University, Atlanta VA Medical Center, VA Ann Arbor Healthcare System, Virginia Commonwealth University, Virginia Commonwealth University Medical Center, Oregon Health & Science University, Portland VA Medical Center, VA Portland Health Care System, VA North Texas Health Care System, Dallas VA Medical Center, The University of Texas Southwestern Medical Center, James A. Haley Veterans' Hospital, Birmingham VA Medical Center, United States Department of Veterans Affairs, Orlando VA Medical Center, VA Long Beach Healthcare System, University of California, Irvine, University of Pittsburgh
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,000
Awards: G3726691970, G5575275685
OpenAlex ID: W4416998607