ABSTRACT
Introduction: The aim of a cancer screening program is to reduce cancerrelated mortality. For that reason patients with liver cirrhosis are enrolled into surveillance through biannual ultrasonography plus AFP to detect single hepatocellular carcinomas (HCC) less than 3 cm, best candidates to apply therapies with curative intent. This study evaluates the impact of the COVID-19 pandemic in the time between detection, diagnosis, and treatment in patients with uninodular HCC < = 3 cm. The secondary objective is to assess the number and sequence of tests needed to achieve the final diagnosis. Aims & Methods: Retrospective inclusion of consecutive patients with final diagnosis of single HCC <= 3 cmat ourcentre. Baseline clinical and analytical variables, date of detection, diagnosis, treatment / entry on the transplant waiting list and the sequence of tests performed (CT, MRI, biopsy) were recorded. Time to diagnosis (period from detection to diagnosis), time to treatment (from diagnosis to date of treatment/entry on the waiting list) and overall time (the sum of the above) were defined. The results were analyzed globally and divided into two periods: pre-COVID (Jan-15 to Feb-2020) and COVID (Mar-20 to the present). Result(s): From Jan 27th2015 to Dec 27th2021, 128 patients of 685 had a final diagnosis of single HCC <= 3 cm, 18% in the pre-COVID era and 22% in the COVID era. Baseline characteristics: median age 64 years old, 84% males, aetiology: alcohol 46%, hepatitis C 39%, fatty liver disease 5%. Child-Pugh class A 86%, BCLC-0 29%, BCLC-A 71%. Median size 20.5 mm, median AFP 5 ng/mL. Only 74% were diagnosed within the screening program. Thermal ablation was applied in 58 patients, liver transplantation in 29, surgical resection in 21 and intraarterial therapy in 16. Twelve patients were left in natural history. Diagnosis was reached by non-invasive criteria (imaging) in 112 patients and by biopsy in 16.The tests performed are shown in the TABLE 1. No statistically significant differences were found in the diagnostic capacity between multiphasic CT (67.6%) and dynamic MRI (73.3%), p-value 0.113. There were no differences in the diagnostic method (imaging versus biopsy) according to the size of the nodule (21.43 mm vs. 21.13 mm), p-value 0.199;nor in the number of studies performed according to the sequence (CT-MR-Biopsy vs MR-CT-Biopsy vs others), p-value 0.746. There were no significant differences neither in the proportion of tumors diagnosed between 10-20 mm and 21-30 mm on the pre-COVID vs COVID era, p-value 0.80, nor in the therapy applied (surgical versus loco-regional, p-value 0.639). Time to diagnosis, time to treatment, and overall time are shown in TABLE 2. Significant differences were found in the time to treatment between the pre-COVID and COVID eras:8 weeks vs 11 weeks, p-value 0.038. Conclusion(s): The COVID pandemic did not affected the proportion of single HCC <=3 cm diagnosed, but it increased the median time from diagnosis to treatment.