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. 2024 Jun;130(10):1697-1708.
doi: 10.1038/s41416-024-02645-3. Epub 2024 Mar 18.

Routes to diagnosis for hepatocellular carcinoma patients: predictors and associations with treatment and mortality

Anya Burton  1   2 , Jennifer Wilburn  3 , Robert J Driver  4 , David Wallace  5   6 , Sean McPhail  3 , Tim J S Cross  7 , Ian A Rowe  4 , Aileen Marshall  8
Affiliations

Routes to diagnosis for hepatocellular carcinoma patients: predictors and associations with treatment and mortality

Anya Burton et al. Br J Cancer. 2024 Jun.

Abstract

Background: Hepatocellular carcinoma (HCC) incidence has increased rapidly, and prognosis remains poor. We aimed to explore predictors of routes to diagnosis (RtD), and outcomes, in HCC cases.

Methods: HCC cases diagnosed 2006-2017 were identified from the National Cancer Registration Dataset and linked to Hospital Episode Statistics and the RtD metric. Multivariable logistic regression was used to explore associations between RtD, diagnosis year, 365-day mortality and receipt of potentially curative treatment.

Results: 23,555 HCC cases were identified; 36.1% via emergency presentation (EP), 30.2% GP referral (GP), 17.1% outpatient referral, 11.0% two-week wait and 4.6% other/unknown routes. Odds of 365-day mortality was >70% lower via GP or OP routes than EP, and odds of curative treatment 3-4 times higher. Further adjustment for cancer/cirrhosis stage attenuated the associations with curative treatment. People who were older, female, had alcohol-related liver disease, or were more deprived, were at increased risk of an EP. Over time, diagnoses via EP decreased, and via GP increased.

Conclusions: HCC RtD is an important predictor of outcomes. Continuing to reduce EP and increase GP and OP presentations, for example by identifying and regularly monitoring patients at higher risk of HCC, may improve stage at diagnosis and survival.

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Conflict of interest statement

All of the authors completed the ICMJE uniform disclosure form; AB declares this work was supported by BTG International Ltd. AM is the chair of HCC UK. TJSC is President elect of the British Association for the Study of the Liver, has shares in AstraZeneca, has given talks for Roche, AstraZeneca, received financial support for educational events from Boston Scientific and Sirtex, works for Roche pharmaceuticals on HCC patient pathways and use of surveillance for HCC, and Roche paid for TJSC’ 2022 attendance at ASCO. IAR reports personal fees from Roche, as well as personal fees from Boehringer Ingelheim outside the submitted work. The other authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Proportion of HCC cases presenting via each main route to diagnosis, 2006–2017.
Upper graph: unadjusted. Middle graph: adjusted for demographics. Lower graph: adjusted for demographic and clinical factors.
Fig. 2
Fig. 2. Kaplan–Meier curves.
Kaplan–Meier 5-year survival by route to diagnosis.
See this image and copyright information in PMC

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