1Department of Internal Medicine.
2Harold C. Simmons Comprehensive Cancer Center.
J Natl Compr Canc Netw. 2021 May 28;19(9):1063-1071. doi: 10.6004/jnccn.2020.7689.
Delays in diagnosis and treatment have been reported for many cancers, with resultant stage migration and worse survival; however, few data exist in patients with hepatocellular carcinoma (HCC). These data are of particular importance in light of the COVID-19 pandemic, which has caused disruptions in healthcare processes and may continue to impact cancer care for the foreseeable future. The aim of our study was to characterize the prevalence and clinical significance of diagnostic and treatment delays in patients with HCC.
We performed a retrospective cohort study of consecutive patients diagnosed with HCC between January 2008 and July 2017 at 2 US health systems. Diagnostic and treatment delays were defined as >90 days between presentation and HCC diagnosis and between diagnosis and treatment, respectively. We used multivariable logistic regression to identify factors associated with diagnostic and treatment delays and Cox proportional hazard models to identify correlates of overall survival.
Of 925 patients with HCC, 39.0% were diagnosed via screening, 33.1% incidentally, and 27.9% symptomatically. Median time from presentation to diagnosis was 37 days (interquartile range, 18-94 days), with 120 patients (13.0%) experiencing diagnostic delays. Median time from HCC diagnosis to treatment was 46 days (interquartile range, 29-74 days), with 17.2% of patients experiencing treatment delays. Most (72.5%) diagnostic delays were related to provider-level factors (eg, monitoring indeterminate nodules), whereas nearly half (46.2%) of treatment delays were related to patient-related factors (eg, missed appointments). In multivariable analyses, treatment delays were not associated with increased mortality (hazard ratio, 0.90; 95% CI, 0.60-1.35); these results were consistent across subgroup analyses by Barcelona Clinic Liver Cancer stage and treatment modality.
Diagnostic and therapeutic delays exceeding 3 months are common in patients with HCC; however, observed treatment delays do not seem to significantly impact overall survival.
许多癌症的诊断和治疗都存在延迟，导致分期转移和生存状况恶化；然而，关于肝细胞癌（HCC）患者的数据却很少。鉴于 COVID-19 大流行导致医疗流程中断，并且在可预见的未来可能继续影响癌症治疗，这些数据显得尤为重要。我们的研究目的是描述 HCC 患者诊断和治疗延迟的流行情况及其临床意义。
我们对 2 家美国医疗系统在 2008 年 1 月至 2017 年 7 月期间连续诊断为 HCC 的患者进行了回顾性队列研究。诊断和治疗延迟分别定义为就诊与 HCC 诊断之间超过 90 天，以及诊断与治疗之间超过 90 天。我们使用多变量逻辑回归来确定与诊断和治疗延迟相关的因素，并使用 Cox 比例风险模型来确定总生存的相关因素。
在 925 例 HCC 患者中，39.0%是通过筛查诊断的，33.1%是偶然诊断的，27.9%是有症状诊断的。从就诊到诊断的中位时间为 37 天（四分位距，18-94 天），有 120 例（13.0%）患者出现诊断延迟。从 HCC 诊断到治疗的中位时间为 46 天（四分位距，29-74 天），有 17.2%的患者出现治疗延迟。大多数（72.5%）的诊断延迟与提供者层面的因素有关（例如，监测不确定的结节），而近一半（46.2%）的治疗延迟与患者相关因素有关（例如，错过预约）。在多变量分析中，治疗延迟与死亡率增加无关（风险比，0.90；95%置信区间，0.60-1.35）；这些结果在按巴塞罗那临床肝癌分期和治疗方式进行的亚组分析中是一致的。
超过 3 个月的 HCC 患者的诊断和治疗延迟很常见；然而，观察到的治疗延迟似乎并没有显著影响总体生存。
