TY - JOUR
T1 - Factors associated with unrecognized cirrhosis in patients with hepatocellular carcinoma
AU - Lee, Yi Te
AU - Karim, Mohammad A.
AU - Kum, Hye Chung
AU - Park, Sulki
AU - Rich, Nicole E.
AU - Noureddin, Mazen
AU - Singal, Amit G.
AU - Yang, Ju Dong
N1 - Funding Information:
Dr. Singal’s research is funded by National Institutes of Health R01 MD012565 and U01 CA230694. Dr. Rich’s research is funded by American College of Gastroenterology Junior Faculty Development Award. Dr. Karim’s research is funded in part by a fellowship supported by the Cancer Prevention and Research Institute of Texas (CPRIT) grant award RP170259 (to Mohammad A. Karim, PhD; PI: Shine Chang, PhD and Sanjay Shete, PhD). Dr. Karim and Dr. Kum’s research is funded in part by the Population Informatics Lab, and the Texas Virtual Data Library (ViDaL) at Texas A&M University. Dr. Yang’s research is supported by American College of Gastroenterology Junior Faculty Development Award and Department of Defense Peer Reviewed Cancer Research Program Career Development Award CA191051 and National Institutes of Health K08 CA259534. The American College of Gastroenterology, the CPRIT, Cedars-Sinai Medical Center, Department of Defense, National Institutes of Health, the Population Informatics Lab, and the ViDaL at Texas A&M University had no role in the collection of data; the design and conduct of the study; management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
© 2023.
PY - 2023/4
Y1 - 2023/4
N2 - BACKGROUND/AIMS: Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and can go undiagnosed for years, leading to underuse of HCC surveillance in clinical practice. We characterized the frequency and associated factors of unrecognized cirrhosis in a national sample of patients with HCC from the United States.METHODS: HCC patients aged 68 years and older, diagnosed during 2011 to 2015 were included from the SEERMedicare Linked Database. If cirrhosis was diagnosed within 6 months immediately preceding HCC diagnosis or after HCC diagnosis, cases were categorized as unrecognized cirrhosis. Factors associated with unrecognized cirrhosis were identified using logistic regression analyses. Factors associated with overall survival were evaluated using Cox regression analyses.RESULTS: Among 5,098 HCC patients, 74.8% patients had cirrhosis. Among those with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR: 2.12, 95% CI: 1.83-2.46), non-Hispanic Black race (aOR: 1.93, 95% CI: 1.45-2.57), and NAFLD etiology (aOR: 4.46, 95% CI: 3.68-5.41) were associated with having unrecognized cirrhosis. Among NAFLD-related HCC patients, male sex (aOR: 2.32, 95% CI: 1.71-3.14) was associated with unrecognized cirrhosis. Unrecognized cirrhosis was independently associated with worse overall survival (aHR: 1.17, 95% CI: 1.08-1.27) compared to recognized cirrhosis.CONCLUSION: Unrecognized cirrhosis is common in NAFLD-related HCC, particularly among male and Black patients, highlighting these groups as important intervention targets to improve HCC surveillance uptake and outcomes.
AB - BACKGROUND/AIMS: Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and can go undiagnosed for years, leading to underuse of HCC surveillance in clinical practice. We characterized the frequency and associated factors of unrecognized cirrhosis in a national sample of patients with HCC from the United States.METHODS: HCC patients aged 68 years and older, diagnosed during 2011 to 2015 were included from the SEERMedicare Linked Database. If cirrhosis was diagnosed within 6 months immediately preceding HCC diagnosis or after HCC diagnosis, cases were categorized as unrecognized cirrhosis. Factors associated with unrecognized cirrhosis were identified using logistic regression analyses. Factors associated with overall survival were evaluated using Cox regression analyses.RESULTS: Among 5,098 HCC patients, 74.8% patients had cirrhosis. Among those with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR: 2.12, 95% CI: 1.83-2.46), non-Hispanic Black race (aOR: 1.93, 95% CI: 1.45-2.57), and NAFLD etiology (aOR: 4.46, 95% CI: 3.68-5.41) were associated with having unrecognized cirrhosis. Among NAFLD-related HCC patients, male sex (aOR: 2.32, 95% CI: 1.71-3.14) was associated with unrecognized cirrhosis. Unrecognized cirrhosis was independently associated with worse overall survival (aHR: 1.17, 95% CI: 1.08-1.27) compared to recognized cirrhosis.CONCLUSION: Unrecognized cirrhosis is common in NAFLD-related HCC, particularly among male and Black patients, highlighting these groups as important intervention targets to improve HCC surveillance uptake and outcomes.
KW - Cancer screening
KW - Hepatocellular carcinoma
KW - Liver cirrhosis
KW - NAFLD
KW - Carcinoma, Hepatocellular/complications
KW - Liver Cirrhosis/complications
KW - Humans
KW - Risk Factors
KW - Liver Neoplasms/complications
KW - Fibrosis
KW - Male
KW - Non-alcoholic Fatty Liver Disease/complications
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U2 - 10.3350/cmh.2022.0450
DO - 10.3350/cmh.2022.0450
M3 - Article
C2 - 36726052
AN - SCOPUS:85153887512
SN - 2287-2728
VL - 29
SP - 453
EP - 464
JO - Clinical and Molecular Hepatology
JF - Clinical and Molecular Hepatology
IS - 2
ER -