Division of Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Clin Transl Gastroenterol. 2024 Jul 1;15(7):e00723. doi: 10.14309/ctg.0000000000000723.
Access to hepatocellular carcinoma (HCC) surveillance and treatments were disrupted during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to characterize the impact of the pandemic on HCC incidence and mortality rates, treatment, and outcomes in the United States.
Two nationwide databases, the United States Cancer Statistics and the National Vital Statistics System, were used to investigate HCC incidence and mortality between 2001 and 2020. Trends in age-adjusted incidence rate (aIR) and adjusted mortality rate (aMR) were assessed using joinpoint analysis. The 2020 aIR and aMR were projected based on the prepandemic data and compared with actual values to assess the extent of underdiagnosis. We assessed differences in HCC characteristics, treatment, and overall survival between 2020 and 2018-2019.
The aIR of HCC in 2020 was significantly reduced compared with 2019 (5.22 vs 6.03/100K person-years [PY]), representing a 12.2% decrease compared with the predicted aIR in 2020 (5.94/100K PY). The greatest extent of underdiagnosis was observed in Black (-14.87%) and Hispanic (-14.51%) individuals and those with localized HCC (-15.12%). Individuals staged as regional or distant HCC were also less likely to receive treatment in 2020. However, there was no significant difference in short-term overall survival in 2020 compared with 2018-2019, with HCC mortality rates remaining stable (aMR: 2.76 vs 2.73/100K PY in 2020 vs 2019).
The COVID-19 pandemic resulted in underdiagnosis of HCC, particularly early stage disease and racial ethnic minorities, and underuse of HCC-directed treatment. Longer follow-up is needed to determine the impact of the COVID-19 pandemic on HCC-related mortality.
在 2019 年冠状病毒病（COVID-19）大流行期间，肝细胞癌（HCC）的监测和治疗机会受到了影响。我们旨在描述大流行对美国 HCC 发病率和死亡率、治疗和结局的影响。
使用美国癌症统计和国家生命统计系统这两个全国性数据库，调查了 2001 年至 2020 年期间 HCC 的发病率和死亡率。使用 Joinpoint 分析评估年龄调整发病率（aIR）和调整死亡率（aMR）的趋势。根据大流行前的数据预测 2020 年的 aIR 和 aMR，并将其与实际值进行比较，以评估漏诊程度。我们评估了 2020 年与 2018-2019 年 HCC 特征、治疗和总体生存率的差异。
与 2019 年相比，2020 年 HCC 的 aIR 显著降低（5.22 比 6.03/100K 人年[PY]），与 2020 年预测的 aIR（5.94/100K PY）相比，下降了 12.2%。在黑人（-14.87%）和西班牙裔（-14.51%）人群以及局限性 HCC 患者中，漏诊程度最大。2020 年局部和远处 HCC 分期的患者接受治疗的可能性也较低。然而，2020 年与 2018-2019 年相比，短期总体生存率没有显著差异，HCC 死亡率保持稳定（2020 年 aMR：2.76 比 2019 年 2.73/100K PY）。
COVID-19 大流行导致 HCC 的漏诊，尤其是早期疾病和少数族裔，以及 HCC 靶向治疗的使用率下降。需要更长时间的随访来确定 COVID-19 大流行对 HCC 相关死亡率的影响。
