Lack of prior screening for advanced liver fibrosis in patients with newly diagnosed hepatocellular carcinoma: Results from a prospective multicentre study

Abstract

Introduction

Hepatocellular carcinoma (HCC) most commonly occurs in a cirrhotic liver. In France, a screening rate of 20 % to 35 % has been reported in clinical cohorts. In these studies, patients were generally enrolled in centers of the same category (university or general hospitals). The aim of this study was to prospectively investigate the circumstances of HCC diagnosis and the causes of HCC screening failure in a cohort of patients from a regional network.

Methods

This prospective multicenter study enrolled patients with newly diagnosed HCC from October 2022 to July 2024. Investigators were from one university hospital, two private clinics, and three general hospitals.

Results

Two hundred patients were included. Diagnosis was made by screening in 31.0 % of cases. Most patients had comorbidities that could lead to screening for liver fibrosis: current or past history of alcohol consumption (74.6 %), diabetes (51.4 %), hypertension (75.7 %), dyslipidemia (47.4 %). The FIB-4 score was ≥ 2.67 in 74.5 % of patients in the “in screening” group and 63.9 % in the “not in -screening” group. Among the 138 patient in the ”not in screening” group, 115 (83.3 %), 34 (24.6), 23 (16.7 %) and 13 (9.4 %) declared they had visited a general practionner, a cardiologist, a gastroenterologist, and/or an endocrinologist within the 12 months prior to HCC diagnosis, respectively.

Conclusion

Recognition by general practitioners of patients at risk of chronic liver disease and identification of advanced fibrosis are major areas for optimization of HCC screening.