A93 HEPATOCELLULAR CARCINOMA SCREENING IN PATIENTS WITH CIRRHOSIS FOLLOWED BY A GASTROENTEROLOGIST- A RETROSPECTIVE STUDY OF HEALTHCARE QUALITY

Abstract Background The American Association for the Study of Liver Diseases (AASLD) guidelines recommend screening for hepatocellular carcinoma (HCC) in adults with cirrhosis every six months by abdominal ultrasound. This recommendation stands for patients with Child-Pugh A / B cirrhosis or Child-Pugh C who are on the transplant waiting list. The rationale behind this guideline is that surveillance for HCC has been shown to improve overall survival. However, in previous studies, rate of adherence to screening was suboptimal. Aims The goal of this study was to define the screening rate in our medical center while collecting demographic and descriptive data (Table 1). Methods We performed a monocentric retrospective study of healthcare quality. Adult patients who had a diagnosis of HCC between July 2010 and February 2018 and who were previously followed in gastroenterology for cirrhosis were included. The delay between the last abdominal imaging available and the first imaging that raised suspicion for or made the HCC diagnosis possible was calculated for each patient. Screening was considered appropriate if it was less than 8 months. Results 102 of the 170 patients had to be excluded from the study because their cirrhosis wasn’t clearly documented before the HCC diagnosis (Figure 1). Amongst included patients, 52% (95% confidence interval 0,39-1,00) had received an appropriate screening for HCC.The average size of HCC at diagnosis was 37 mm and 53% had multicentric distribution. 56% of patients received treatment, with chemoembolization being the most frequently used in our population. 49% and 80% of patients had passed away at 1 and 3 years post-diagnosis, respectively. 52% of patients had normal alpha-feto-protein (AFP) initially. Conclusions Although limited in statistical power by the size of its sample, our study still sheds an interesting light on the reality of HCC screening in a Canadian hospital. The rate of appropriate screening, although suboptimal, is comparable to those reported in the literature elsewhere in the world. The dark prognosis associated with this disease is also illustrated. The proportion of patients who were excluded from the study due to occult cirrhosis highlights the importance of establishing this diagnosis so that screening recommendations can be put into practice. Further studies of larger scale would be needed to assess the causes of screening issues. Funding Agencies None

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