Impact of the COVID-19 Pandemic on Liver Cancer Staging at a Multidisciplinary Liver Cancer Clinic

Daniel Li; Angela Y Jia; Jane Zorzi; Paige Griffith; Amy K Kim; Doan Dao; Robert A Anders; Christos Georgiades; Robert P Liddell; Kelvin Hong; Nilofer S Azad; Won Jin Ho; Marina Baretti; Eric Christenson; Azarakhsh Baghdadi; Ihab R Kamel; Jeffrey Meyer; Elie Ghabi; Richard A Burkhart; Kelly Lafaro; Jin He; Chris Shubert; Mark Yarchoan

doi:10.1097/AS9.0000000000000207

Impact of the COVID-19 Pandemic on Liver Cancer Staging at a Multidisciplinary Liver Cancer Clinic

Ann Surg Open. 2022 Oct 3;3(4):e207. doi: 10.1097/AS9.0000000000000207. eCollection 2022 Dec.

Authors

Daniel Li¹, Angela Y Jia², Jane Zorzi¹, Paige Griffith¹, Amy K Kim³, Doan Dao³, Robert A Anders⁴, Christos Georgiades⁵, Robert P Liddell⁵, Kelvin Hong⁵, Nilofer S Azad¹, Won Jin Ho¹, Marina Baretti¹, Eric Christenson¹, Azarakhsh Baghdadi⁶, Ihab R Kamel⁶, Jeffrey Meyer², Elie Ghabi⁷, Richard A Burkhart⁷, Kelly Lafaro⁷, Jin He⁷, Chris Shubert⁷, Mark Yarchoan¹

Affiliations

¹ Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD.
² Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
³ Department of Medicine, Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, MD.
⁴ Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD.
⁵ Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.
⁶ Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
⁷ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.

Abstract

To compare liver cancer resectability rates before and during the COVID-19 pandemic.

Background: Liver cancers usually present with nonspecific symptoms or are diagnosed through screening programs for at-risk patients, and early detection can improve patient outcomes. In 2020, the COVID-19 pandemic upended medical care across all specialties, but whether the pandemic was associated with delays in liver cancer diagnosis is not known.

Methods: We performed a retrospective review of all patients evaluated at the Johns Hopkins Multidisciplinary Liver Cancer Clinic from January 2019 to June 2021 with a new diagnosis of suspected or confirmed hepatocellular carcinoma (HCC) or biliary tract cancer (BTC).

Results: There were 456 liver cancer patients (258 HCC and 198 BTC). From January 2019 to March 2020 (pre-pandemic), the surgical resectability rate was 20%. The subsequent 6 months (early pandemic), the resectability rate decreased to 11%. Afterward from October 2020 to June 2021 (late pandemic), the resectability rate increased to 27%. The resectability rate early pandemic was significantly lower than that for pre-pandemic and later pandemic combined (11% lower; 95% confidence interval [CI], 2%-20%). There was no significant difference in resectability rates pre-pandemic and later pandemic (7% difference; 95% CI, -3% to 16%). In subgroup analyses, the early pandemic was associated with a larger impact in BTC resectability rates than HCC resectability rates. Time from BTC symptom onset until Multidisciplinary Liver Clinic evaluation increased by over 6 weeks early pandemic versus pre-pandemic (Hazard Ratio, 0.63; 95% CI, 0.44-0.91).

Conclusions: During the early COVID-19 pandemic, we observed a drop in the percentage of patients presenting with curable liver cancers. This may reflect delays in liver cancer diagnosis and contribute to excess mortality related to the COVID-19 pandemic.

Keywords: COVID-19; bile duct cancer; cholangiocarcinoma; hepatocellular carcinoma; liver cancer.

Abstract

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