Low ES, Apostolov R, Wong D, Lin S, Kutaiba N, Grace JA, Sinclair M. Hepatocellular carcinoma surveillance and quantile regression for determinants of underutilisation in at-risk Australian patients. World J Gastrointest Oncol 2021; 13(12): 2149-2160 [PMID: 35070048 DOI: 10.4251/wjgo.v13.i12.2149]
Corresponding Author of This Article
Elizabeth SL Low, MBBS, Doctor, Department of Gastroenterology and Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia. elizabeth_low312@hotmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Dec 15, 2021; 13(12): 2149-2160 Published online Dec 15, 2021. doi: 10.4251/wjgo.v13.i12.2149
Hepatocellular carcinoma surveillance and quantile regression for determinants of underutilisation in at-risk Australian patients
Elizabeth SL Low, Ross Apostolov, Darren Wong, Sandra Lin, Numan Kutaiba, Josephine A Grace, Marie Sinclair
Elizabeth SL Low, Ross Apostolov, Darren Wong, Josephine A Grace, Marie Sinclair, Department of Gastroenterology and Liver Transplant Unit, Austin Health, Heidelberg 3084, Victoria, Australia
Ross Apostolov, Josephine A Grace, Marie Sinclair, Department of Medicine, University of Melbourne, Melbourne 3000, Victoria, Australia
Sandra Lin, Department of Radiology, Monash Health, Clayton 3168, Victoria, Australia
Numan Kutaiba, Department of Radiology, Austin Health, Heidelberg 3084, Victoria, Australia
Author contributions: Low ES, Apostolov R, Lin S and Kutaiba N directly designed and performed the study, with contribution from Sinclair M, Wong D and Grace J; Low ESL, Lin S and Wong D collated and analysed the data; Low ESL wrote the paper, with revisions and editing by all other listed authors.
Institutional review board statement: This study was approved by the Austin Health Research Ethics Committee (ID 19/114) and carried out in line with the National Statement on Ethical Conduct in Human Research (2007).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest or financial supports.
Data sharing statement: Patient consent was not obtained but the presented data are anonymised and risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Elizabeth SL Low, MBBS, Doctor, Department of Gastroenterology and Liver Transplant Unit, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia. elizabeth_low312@hotmail.com
Received: April 16, 2021 Peer-review started: April 16, 2021 First decision: June 27, 2021 Revised: July 13, 2021 Accepted: September 19, 2021 Article in press: September 19, 2021 Published online: December 15, 2021
Abstract
BACKGROUND
While clinical guidelines recommend hepatocellular carcinoma (HCC) surveillance for at-risk individuals, reported surveillance rates in the United States and Europe remain disappointingly low.
AIM
To quantify HCC surveillance in an Australian cohort, and assess for factors associated with surveillance underutilisation.
METHODS
All patients undergoing HCC surveillance liver ultrasounds between January 1, 2018 to June 30, 2018 at a tertiary hospital in Melbourne, Australia, were followed until July 31, 2020, or when surveillance was no longer required. The primary outcome was the percentage of time up-to-date with HCC surveillance (PTUDS). Quantile regression was performed to determine the impact of factors associated with HCC surveillance underutilisation.
RESULTS
Among 775 at-risk patients followed up for a median of 27.5 months, the median PTUDS was 84.2% (IQR: 66.3%-96.3%). 85.0% of patients were followed up by specialist gastroenterologists. Amongst those receiving specialist care, quantile regression demonstrated differential associations at various quantile levels of PTUDS for several factors. Older age at the 25th quantile (estimate 0.002 per percent, P = 0.03), and cirrhotic status at the 75th quantile (estimate 0.021, P = 0.017), were significantly associated with greater percentage of time up-to-date. African ethnicity (estimate -0.089, P = 0.048) and a culturally and linguistically diverse (CALD) background (estimate -0.063, P = 0.01) were significantly associated with lower PTUDS at the 50th quantile, and again for CALD at the 75th quantile (estimate -0.026, P = 0.045).
CONCLUSION
While median PTUDS in this Australian cohort study was 84.2%, awareness of the impact of specific factors across PTUDS quantiles can aid targeted interventions towards improved HCC surveillance.
Core Tip: This study evaluated the uptake of liver cancer screening in a cohort of high-risk Australians, and found that on average, patients were up-to-date with their surveillance for 84.2% of the study time period. Certain factors, such as absence of cirrhosis, younger age, African ethnicity and a non-English speaking background were associated to varying degrees with lower time up-to-date with hepatocellular carcinoma screening.
