Factors that Affect the Surveillance and Late-Stage Detection of a Newly Diagnosed Hepatocellular Carcinoma

Abstract

Background: Surveillance of hepatocellular carcinoma (HCC) is beneficial for detecting early-stage HCC. The factors that influence adherence to HCC surveillance and late-stage detection have never been evaluated. We investigated the predictive factors that contribute to patients accessing regular HCC surveillance and their association with the detection of late-stage HCC at the time of diagnosis. Methods: We conducted a prospective observational study at Hatyai Hospital (Songkhla, Thailand) between 2014 and 2016. HCC surveillance includes performing hepatic ultrasonography with/without serum alpha-fetoprotein 6–12 months before the detection of HCC. Logistic regression analyses were conducted separately to examine the relationship between the variables and each endpoint. Results: One hundred ninety-nine HCC patients were enrolled in the study; most patients were of low socioeconomic status, 90.5% had less than a bachelor’s degree, and 69.3% of patients had a monthly income of <10,000 baths (US $312.50). Nearly all (93.5%) patients had cirrhosis, 39.7% had hepatitis B virus (HBV) infection, 24.6% had hepatitis C virus infection, and 24.6% had alcohol-related liver disease. The risk of HCC was recognized in 51.8% of patients, and regular HCC surveillance was achieved in 36.2% of patients. Multivariate logistic regression analysis revealed that a monthly income >10,000 baths (US $312.50) (odds ratio [OR], 4.566; p = 0.013), HBV infection (OR, 0.188; p = 0.001), and recognition of patients at risk of HCC (OR, 130.396; p<0.001) were independent predictive factors for adherence to HCC surveillance. Regular HCC surveillance (OR, 0.215; p = 0.003) and recognition of HBV infection (OR, 0.356; p = 0.040) were independent preventive factors for the detection of late-stage HCC at the time of diagnosis. Conclusion: In Thailand, awareness of patients at risk of developing HCC and the rate of regular HCC surveillance are low. Greater awareness will enable physicians to surveil and detect HCC.

Prevalence of Hepatocellular Carcinoma in Hepatitis B Population within Southeast Asia: A Systematic Review and Meta-Analysis of 39,050 Participants

“…The high incidence of HBV and the lack of success of national immunisation programmes and schemes are the most likely causes of the high prevalence of HCC in this country [72][73][74][75]. The extensive range of HCC case counts reflects the regional differences and heterogeneity in the incidence and consequences of HBV-related HCC in Southeast Asia [76]. The estimates in this study put the combined prevalence of HCC among HBV cases in this area at 45.8%.…”

“…Even though there have been more studies in recent years, the prevalence estimates were lower than in the past. This may be due to several factors, including shifts in population demographics, improvements in medical procedures, risk factors, or developing research methodology [76,[97][98][99][100][101]. Lim et al (2021) and Nguyen-Dinh et al (2018) both reported cases of HBV in Singapore and Vietnam.…”

Regional Differences in Admissions and Treatment Outcomes for Hepatocellular Carcinoma Patients in Thailand

“…They would have had to pay their own travel expenses, as this is not covered by the NHSO, as well as lose time and income for traveling. A recent study reported that the patient's income level was a significant factor in adherence to HCC surveillance, and a monthly income of more than 10,000 Baht was a significant factor for adherence (OR 4.6, 95%CI 1.37-15.21) (Rattanasupar et al, 2021). Unfortunately, another study found that 50-90% of patients covered by NHSO at sub-district rural hospitals had incomes less than 7,500 Baht per month (Kitreerawutiwong et al, 2017).…”

Prospects of liquid biopsy in the prognosis and clinical management of gastrointestinal cancers

“…The global incidence of esophageal cancer varies, with mortality rates often high due to late-stage detection ( Joseph et al, 2022 ). Liver cancer (hepatocellular carcinoma, HCC) incidence is linked to factors like viral infections and lifestyle choices, resulting in high mortality rates, often due to late-stage diagnosis ( Rattanasupar et al, 2021 ). Pancreatic cancer, which is challenging to treat and frequently diagnosed at advanced stages, registers lower survival rates among gastrointestinal cancers ( Li C. et al, 2022 ).…”