The Real-World Prevalence of Esophagogastric Varices, Bleeding, Emergency Room Visits, and Hospitalization Among Patients with Advanced Hepatocellular Carcinoma in the United States: A Retrospective Cohort Study.

Abstract

Purpose: Esophagogastric varices (EGV) and upper gastrointestinal bleeding are common and potentially fatal complications in patients with advanced hepatocellular carcinoma (aHCC). We aimed to evaluate the real-world prevalence of EGV among the aHCC population in the United States.

Patients and methods: This retrospective cohort study utilized IQVIA's PharMetrics Plus Health Plans Claims database between January 1, 2016, and July 31, 2021 (study period). Adult patients with an aHCC diagnosis who initiated systemic therapies were included, while those with any secondary malignancies or prior liver transplant at baseline were excluded. The date of therapy initiation was the index date; baseline characteristics, prior procedures, and clinical events of interest were captured during the 12-month pre-index (baseline) period. Patients were followed for clinical outcomes (EGV- or bleeding-related emergency room [ER] visits or hospitalization) during the 6-month post-index period. Logistic regression was conducted to identify key predictors of post-index EGV- or bleeding-related ER visit or hospitalization.

Results: 904 patients with aHCC were included in the study (mean age: 61.3 years; 75.3% male). Sorafenib (423 patients, 46.8%) was the most prescribed aHCC treatment. During the entire study period, 458 patients (50.7%) underwent an esophagogastroduodenoscopy (EGD), of whom 209 (45.6%) had post-index EGV. Among 327 patients (36.2%) with a baseline EGD, 175 (53.5%) were diagnosed with EGV and 50 (15.3%) had variceal bleeding; 141 patients (15.6% of all patients) experienced ≥1 EGV- or bleeding-related ER visit or hospitalization post-index.

Conclusion: There is a high prevalence of EGV in patients with aHCC. The presence of EGV, gastrointestinal bleeding, and portal hypertension-related comorbidities was associated with an increased risk of subsequent EGV- or bleeding-related ER visits or hospitalizations in patients with aHCC. Assessment and stratification of varices should be considered in patients with aHCC before initiating systemic therapies to inform treatment decisions.