Hepatocellular carcinoma surveillance and quantile regression for determinants of underutilisation in at-risk Australian patients

doi:10.4251/wjgo.v13.i12.2149

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World Journal of Gastrointestinal Oncology

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World J Gastrointest Oncol. Dec 15, 2021; 13(12): 2149-2160
Published online Dec 15, 2021. doi: 10.4251/wjgo.v13.i12.2149

Hepatocellular carcinoma surveillance and quantile regression for determinants of underutilisation in at-risk Australian patients

Elizabeth SL Low, Ross Apostolov, Darren Wong, Sandra Lin, Numan Kutaiba, Josephine A Grace, Marie Sinclair

Elizabeth SL Low, Ross Apostolov, Darren Wong, Josephine A Grace, Marie Sinclair, Department of Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia

Ross Apostolov, Josephine A Grace, Marie Sinclair, Department of Medicine, University of Melbourne, Melbourne 3000, Victoria, Australia

Sandra Lin, Department of Radiology, Monash Health, Clayton 3168, Victoria, Australia

Numan Kutaiba, Department of Radiology, Austin Health, Heidelberg 3084, Victoria, Australia

Author contributions: Low ES, Apostolov R, Lin S and Kutaiba N directly designed and performed the study, with contribution from Sinclair M, Wong D and Grace J; Low ESL, Lin S and Wong D collated and analysed the data; Low ESL wrote the paper, with revisions and editing by all other listed authors.

Institutional review board statement: This study was approved by the Austin Health Research Ethics Committee (ID 19/114) and carried out in line with the National Statement on Ethical Conduct in Human Research (2007).

Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.

Conflict-of-interest statement: The authors declare no conflicts of interest or financial supports.

Data sharing statement: Patient consent was not obtained but the presented data are anonymised and risk of identification is low. No additional data are available.

Corresponding author: Elizabeth SL Low, MBBS, Doctor, Department of Gastroenterology and Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia. elizabeth_low312@hotmail.com

Received: April 16, 2021
Peer-review started: April 16, 2021
First decision: June 27, 2021
Revised: July 13, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: December 15, 2021
Processing time: 242 Days and 21 Hours

Abstract

BACKGROUND

While clinical guidelines recommend hepatocellular carcinoma (HCC) surveillance for at-risk individuals, reported surveillance rates in the United States and Europe remain disappointingly low.

AIM

To quantify HCC surveillance in an Australian cohort, and assess for factors associated with surveillance underutilisation.

METHODS

All patients undergoing HCC surveillance liver ultrasounds between January 1, 2018 to June 30, 2018 at a tertiary hospital in Melbourne, Australia, were followed until July 31, 2020, or when surveillance was no longer required. The primary outcome was the percentage of time up-to-date with HCC surveillance (PTUDS). Quantile regression was performed to determine the impact of factors associated with HCC surveillance underutilisation.

RESULTS

Among 775 at-risk patients followed up for a median of 27.5 months, the median PTUDS was 84.2% (IQR: 66.3%-96.3%). 85.0% of patients were followed up by specialist gastroenterologists. Amongst those receiving specialist care, quantile regression demonstrated differential associations at various quantile levels of PTUDS for several factors. Older age at the 25^thquantile (estimate 0.002 per percent, P = 0.03), and cirrhotic status at the 75^thquantile (estimate 0.021, P = 0.017), were significantly associated with greater percentage of time up-to-date. African ethnicity (estimate -0.089, P = 0.048) and a culturally and linguistically diverse (CALD) background (estimate -0.063, P = 0.01) were significantly associated with lower PTUDS at the 50^thquantile, and again for CALD at the 75^thquantile (estimate -0.026, P = 0.045).

CONCLUSION

While median PTUDS in this Australian cohort study was 84.2%, awareness of the impact of specific factors across PTUDS quantiles can aid targeted interventions towards improved HCC surveillance.

Keywords: Liver cirrhosis; Hepatitis, viral, human; Carcinoma, hepatocellular; Liver neoplasms; Early detection of cancer; Population surveillance

Core Tip: This study evaluated the uptake of liver cancer screening in a cohort of high-risk Australians, and found that on average, patients were up-to-date with their surveillance for 84.2% of the study time period. Certain factors, such as absence of cirrhosis, younger age, African ethnicity and a non-English speaking background were associated to varying degrees with lower time up-to-date with hepatocellular carcinoma screening.