Hepatocellular Carcinoma Surveillance in Cirrhosis Patients at U.S. Safety-Net Health Systems.

Abstract

Objective: Surveillance for hepatocellular carcinoma (HCC) in cirrhosis patients is associated with improved patient outcomes. We aim to evaluate real-world utilization of HCC surveillance among safety-net populations with cirrhosis.

Methods: We performed a retrospective cohort study of adults with cirrhosis across four safety-net hospitals from March 1, 2017 to February 28, 2022. Receipt of abdominal imaging with ultrasound, computed tomography, or magnetic resonance imaging and the corresponding ICD-9-CM/ICD-10-CM diagnosis codes at 6 months and 12 months were used to assess HCC surveillance.

Results: Among 14,556 patients with cirrhosis (61.8% male, 73.0% non-white ethnic minorities, 54.4% with Medicaid or indigent care/uninsured), 70.9% and 78.1% received abdominal imaging agnostic to indication within 6-months and 12-months, respectively. When evaluating receipt of abdominal imaging with a specific indication for HCC surveillance, 29.1% and 34.0% of patients received surveillance within 6 months and 12 months, respectively. On adjusted multivariable regression, greater odds of HCC surveillance were observed in older patients, ethnic minorities, and those with commercial insurance. Lower odds of HCC surveillance were observed in patients with indigent care (vs. Medicare: OR 0.85, 95% CI 0.72 - 1.00), those with drug use (OR 0.63, 95% CI 0.55 - 0.71), and concurrent mental health/psychiatric diagnoses (OR 0.88, 95% CI 0.80 - 0.97).

Conclusions: Among a multi-center safety-net cohort of cirrhosis patients, fewer than 30% received HCC surveillance within 6 months. While greater proportions received abdominal imaging agnostic to indication, the clinical benefit of these examinations for HCC surveillance may be limited due concerns with abbreviated protocols, quality, and interpretation.