Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area

Giuliana Amaddeo; Raffaele Brustia; Manon Allaire; Marie Lequoy; Clémence Hollande; Hélène Regnault; Lorraine Blaise; Nathalie Ganne-Carrié; Olivier Séror; Edouard Larrey; Chetana Lim; Olivier Scatton; Sanaa El Mouhadi; Violaine Ozenne; François Paye; Pierre Balladur; Anthony Dohan; Pierre-Philippe Massault; Stanislas Pol; Marco Dioguardi Burgio; Valérie Vilgrain; Ailton Sepulveda; Francois Cauchy; Alain Luciani; Daniele Sommacale; Vincent Leroy; Francoise Roudot-Thoraval; Mohamed Bouattour; Jean-Charles Nault; Paris Liver Cancer Group

doi:10.1016/j.jhepr.2020.100199

Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area

JHEP Rep. 2021 Feb;3(1):100199. doi: 10.1016/j.jhepr.2020.100199. Epub 2020 Dec 22.

Authors

Giuliana Amaddeo^{1

2

3}, Raffaele Brustia⁴, Manon Allaire^{5

6}, Marie Lequoy⁷, Clémence Hollande⁸, Hélène Regnault¹, Lorraine Blaise⁹, Nathalie Ganne-Carrié^{9

10}, Olivier Séror^{10

11

12}, Edouard Larrey^{5

6}, Chetana Lim¹³, Olivier Scatton^{6

13}, Sanaa El Mouhadi¹⁴, Violaine Ozenne⁷, François Paye¹⁵, Pierre Balladur¹⁵, Anthony Dohan¹⁶, Pierre-Philippe Massault¹⁷, Stanislas Pol⁸, Marco Dioguardi Burgio^{11

12}, Valérie Vilgrain^{11

12}, Ailton Sepulveda¹⁸, Francois Cauchy¹⁸, Alain Luciani^{2

19}, Daniele Sommacale^{2

3

4}, Vincent Leroy^{1

2

3}, Francoise Roudot-Thoraval¹, Mohamed Bouattour²⁰, Jean-Charles Nault^{9

10}; Paris Liver Cancer Group

Affiliations

¹ Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France.
² Paris Est Créteil University, UPEC, Créteil, France.
³ INSERM U955, Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", Assistance Publique-Hôpitaux de Paris, Créteil, France.
⁴ Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France.
⁵ Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France.
⁶ Sorbonne Université, Paris, France.
⁷ Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France.
⁸ Department of Hepatology, AP-HP, Hôpital Cochin, Paris, France.
⁹ Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France.
¹⁰ Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France.
¹¹ Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France.
¹² INSERM U1149 "Centre de Recherche sur l'Inflammation", CRI, Paris, France.
¹³ Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France.
¹⁴ Department of Radiology, AP-HP, Hôpital Saint Antoine, Paris, France.
¹⁵ Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France.
¹⁶ Department of Radiology, AP-HP, Hôpital Cochin, Université de Paris, Paris, France.
¹⁷ Department of Digestive Surgery, AP-HP, Hôpital Cochin, Université de Paris, Paris, France.
¹⁸ Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France.
¹⁹ Department of Radiology, AP-HP, Hôpital Henri-Mondor, Créteil, France.
²⁰ Département d'Oncologie Digestive, AP-HP, Hôpital Beaujon, Clichy, France.

Abstract

Background & aims: Patients affected by hepatocellular carcinoma (HCC) represent a vulnerable population during the COVID-19 pandemic and may suffer from altered allocation of healthcare resources. The aim of this study was to determine the impact of the COVID-19 pandemic on the management of patients with HCC within 6 referral centres in the metropolitan area of Paris, France.

Methods: We performed a multicentre, retrospective, cross-sectional study on the management of patients with HCC during the first 6 weeks of the COVID-19 pandemic (exposed group), compared with the same period in 2019 (unexposed group). We included all patients discussed in multidisciplinary tumour board (MTB) meetings and/or patients undergoing a radiological or surgical programmed procedure during the study period, with curative or palliative intent. Endpoints were the number of patients with a modification in the treatment strategy, or a delay in decision-to-treat.

Results: After screening, n = 670 patients were included (n = 293 exposed to COVID, n = 377 unexposed to COVID). Fewer patients with HCC presented to the MTB in 2020 (p = 0.034) and fewer had a first diagnosis of HCC (n = 104 exposed to COVID, n = 143 unexposed to COVID, p = 0.083). Treatment strategy was modified in 13.1% of patients, with no differences between the 2 periods. Nevertheless, 21.5% vs. 9.5% of patients experienced a treatment delay longer than 1 month in 2020 compared with 2019 (p <0.001). In 2020, 7.1% (21/293) of patients had a diagnosis of an active COVID-19 infection: 11 (52.4%) patients were hospitalised and 4 (19.1%) patients died.

Conclusions: In a metropolitan area highly impacted by the COVID-19 pandemic, we observed fewer patients with HCC, and similar rates of treatment modification, but with a significantly longer treatment delay in 2020 vs. 2019.

Lay summary: During the coronavirus disease 2019 (COVID-19) pandemic era, fewer patients with hepatocellular carcinoma (HCC) presented to the multidisciplinary tumour board, especially with a first diagnosis of HCC. Patients with HCC had a treatment delay that was longer in the COVID-19 period than in 2019.

Keywords: 2019-nCoV; BCLC, Barcelona Clinic Liver Cancer; COVID-19; Cirrhosis; EASL, European Association for the Study of Liver; HCC, hepatocellular carcinoma; Hepatocellular carcinoma; ICU, intensive care unit; IQR, inter-quartile range; IR, interventional radiology; ITT, intention to treat; LR, liver resection; LT, liver transplantation; MELD, model for end-stage liver disease; MTB, multidisciplinary tumour board; Management; NASH, non-alcoholic steatohepatitis; OR, odds ratio; SIRT, selective internal radiation therapy; TACE, transarterial chemoembolisation; aOR, adjusted OR.