Wong Robert J, Jones Patricia D, Niu Bolin, Pinheiro Paulo, Thamer Mae, Kshirsagar Onkar, Zhang Yi, Fass Ronnie, Therapondos George, Singal Amit G, Khalili Mandana
Division of Gastroenterology and Hepatology, Stanford University School of Medicine and Gastroenterology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California, USA.
Division of Digestive Health and Liver Diseases, University of Miami School of Medicine and Jackson Memorial Health System, Miami, Florida, USA.
Clin Transl Gastroenterol. 2025 Jun 25;16(8):e00877. doi: 10.14309/ctg.0000000000000877. eCollection 2025 Aug 1.
Surveillance for hepatocellular carcinoma (HCC) in patients with cirrhosis is associated with improved patient outcomes. We aim to evaluate real-world utilization of HCC surveillance among safety-net populations with cirrhosis.
We performed a retrospective cohort study of adults with cirrhosis across 4 safety-net health systems 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.
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 the 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: odds ratio [OR] 0.85, 95% confidence interval [CI] 0.72-1.00), 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).
Among a multicenter safety-net cohort of patients with cirrhosis, 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 because of concerns with abbreviated protocols, quality, and interpretation.
对肝硬化患者进行肝细胞癌（HCC）监测可改善患者预后。我们旨在评估肝硬化安全网人群中HCC监测的实际应用情况。
我们对2017年3月1日至2022年2月28日期间4个安全网医疗系统中的成年肝硬化患者进行了一项回顾性队列研究。通过腹部超声、计算机断层扫描或磁共振成像进行的腹部成像检查以及6个月和12个月时相应的ICD-9-CM/ICD-10-CM诊断代码用于评估HCC监测情况。
在14556例肝硬化患者中（61.8%为男性，73.0%为非白人少数族裔，54.4%有医疗补助或贫困护理/未参保），分别有70.9%和78.1%的患者在6个月和12个月内接受了无特定指征的腹部成像检查。当评估有HCC监测特定指征的腹部成像检查接受情况时，分别有29.1%和34.0%的患者在6个月和12个月内接受了监测。在调整后的多变量回归分析中，老年患者、少数族裔以及有商业保险的患者接受HCC监测的几率更高。贫困护理患者（与医疗保险患者相比：优势比[OR]为0.85，95%置信区间[CI]为0.72-1.00）、药物使用者（OR为0.63，95%CI为0.55-0.71）以及同时患有精神健康/精神疾病诊断的患者（OR为0.88，95%CI为0.80-0.97）接受HCC监测的几率较低。
在一个多中心安全网肝硬化患者队列中，不到30%的患者在6个月内接受了HCC监测。虽然有更大比例的患者接受了无特定指征的腹部成像检查，但由于对简化方案、质量和解读的担忧，这些检查对HCC监测的临床益处可能有限。
