Saleh Sherif, Mohammed Abdul, Davila Josue, Paranji Neethi, Niu Bolin
Internal Medicine, MetroHealth Medical Center, Cleveland, USA.
Hospital Medicine, Cleveland Clinic Foundation, Cleveland, USA.
Cureus. 2022 Mar 26;14(3):e23516. doi: 10.7759/cureus.23516. eCollection 2022 Mar.
Background Patients with psychiatric disorders are at an increased risk of developing liver diseases, including hepatocellular carcinoma (HCC). HCC is a leading cause of cancer-related deaths in the United States. The aim of this study was to re-examine the association of psychiatric illness with HCC and assess its impact on screening practices and the outcomes of HCC. Materials and methods We performed a retrospective manual chart review of all patients diagnosed with HCC at a major safety-net hospital in Cleveland, Ohio, from January 2010 to December 2019. Patients were divided into two groups, those with and those without psychiatric illness. The patient characteristics recorded included psychiatric illnesses, etiology of liver disease, radiographic screening intervals, and tumor board recommendations upon initial diagnosis. We analyzed data using Statistical Product and Service Solutions version 26.0 (IBM Corp., Armonk, NY). We analyzed the qualitative and quantitative differences between the groups using the chi-square or Fisher's exact tests for categorical variables and t-test for continuous variables. Results There were a total of 393 patients with a diagnosis of HCC. Among them, 128 (32.5%) were diagnosed with at least one psychiatric illness. Fewer patients with psychiatric illness (33.6%) underwent screening within six months before being diagnosed with HCC compared to those without psychiatric illness (49.8%) (p = 0.002). Patients with psychiatric illness (71.1%) were more likely to have been seen by a gastroenterologist or hepatologist before their diagnosis of HCC compared to those without psychiatric illness (55.1%) (p =0.002). Patients with psychiatric illness were more likely to be offered systemic chemotherapy or hospice (39.1%) compared to those without psychiatric illness (29.1%) (p =0.039). Discussion A significant number of HCC patients in our study group have an underlying psychiatric illness. Patients with psychiatric disorders are prone to high-risk behaviors, likely predisposing them to chronic liver disease and HCC. Patients with psychiatric disorders are less compliant with screening practices. Our findings suggest that psychiatric illnesses tend to be diagnosed with more extensive HCC, which is less amenable to curative treatment. Significant efforts need to be made to identify barriers to HCC screening in cirrhotic patients with psychiatric disorders.
患有精神疾病的患者患肝病（包括肝细胞癌（HCC））的风险增加。HCC是美国癌症相关死亡的主要原因。本研究的目的是重新审视精神疾病与HCC的关联，并评估其对筛查实践和HCC结局的影响。
我们对2010年1月至2019年12月在俄亥俄州克利夫兰一家大型安全网医院诊断为HCC的所有患者进行了回顾性手工病历审查。患者分为两组，有精神疾病组和无精神疾病组。记录的患者特征包括精神疾病、肝病病因、影像学筛查间隔以及初次诊断时的肿瘤委员会建议。我们使用统计产品与服务解决方案26.0版（IBM公司，纽约州阿蒙克）分析数据。我们使用卡方检验或Fisher精确检验分析分类变量组间的定性和定量差异，使用t检验分析连续变量组间的差异。
共有393例诊断为HCC的患者。其中，128例（32.5%）被诊断患有至少一种精神疾病。与无精神疾病的患者（49.8%）相比，患有精神疾病的患者在被诊断为HCC前六个月内接受筛查的比例较低（33.6%）（p = 0.002）。与无精神疾病的患者（55.1%）相比，患有精神疾病的患者在诊断为HCC之前更有可能看过胃肠病学家或肝病学家（71.1%）（p = 0.002）。与无精神疾病的患者（29.1%）相比，患有精神疾病的患者更有可能接受全身化疗或临终关怀（39.1%）（p = 0.039）。
我们研究组中有相当数量的HCC患者患有潜在的精神疾病。患有精神疾病的患者容易出现高危行为，这可能使他们易患慢性肝病和HCC。患有精神疾病的患者对筛查实践的依从性较低。我们的研究结果表明，精神疾病往往与更广泛的HCC相关，而这种HCC较难接受根治性治疗。需要做出重大努力来确定患有精神疾病的肝硬化患者进行HCC筛查的障碍。
