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Undetected cirrhosis common at HCC diagnosis

In a U.S. Veteran population, a majority of patients with hepatocellular carcinoma had undetected cirrhosis at the time carcinoma was diagnosed. These patients were also more likely to have advanced stage HCC.

“The findings from the study may suggest that under-recognition of cirrhosis might, at least in part, explain the disconnection between the expected and observed benefits associated with HCC screening practices in the [U.S.],” the researchers wrote.

Researchers analyzed electronic medical records of a random sample of 1,500 patients diagnosed with HCC found in the National Veterans Affairs system between 2005 and 2011. Multivariable analyses were conducted using patients’ demographics, comorbidities, aetiology of underlying disease and health care utilization.

Overall, 1,201 patients presented with HCC and cirrhosis (80.1%). Of these, 296 did not recall any mention of cirrhosis by their health care provider prior to HCC diagnosis (24.6%). Patients with unrecognized cirrhosis had fewer clinician visits in the year prior to HCC diagnosis (32.4%) compared with patients with recognized cirrhosis (45.7%; P < .001).

Patients with a greater likelihood of having unrecognized cirrhosis were aged more than 65 years (OR = 2.32; 95% CI, 1.56-3.45), African-American (OR = 1.93; 95% CI, 1.29-2.89), patients with alcoholic liver disease (OR = 1.69; 95% CI, 1.06-2.67), nonalcoholic fatty liver disease (OR = 4.77; 95% CI, 2.43-9.34), HIV (OR = 3.02; 95% CI, 1.11-8.16) and fewer comorbidities (Deyo score 0 vs. 3; OR = 2.42; 95% CI, 1.53-3.83) compared with patients with recognized cirrhosis.

Of the patients with unrecognized cirrhosis, 177 were diagnosed at early stage HCC (14.7%) compared with other patients who were diagnosed at advanced HCC. These patients were 6.5 times more likely to have advanced stage HCC at diagnosis. The impact of cirrhosis recognition on HCC stage remained high even after adjusting for pre-specified covariates (OR = 3.37; 95% CI, 1.69-6.7).

“The failure to recognize cirrhosis was strongly associated with advanced stage at the time of HCC diagnosis,” the researchers wrote.

The researchers concluded: “Our results emphasize that optimizing outcomes in HCC depends on timely identification of cirrhosis, particularly in these at-risk groups, to implement adequate screening and diagnose cancer at an early enough stage that patients can benefit from potentially curative treatments.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.