Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area.
Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area.
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DOI：
10.1016/j.jhepr.2020.100199
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Paris Liver Cancer Group
中科院分区：
文献类型：
--
作者：
Amaddeo G;Brustia R;Allaire M;Lequoy M;Hollande C;Regnault H;Blaise L;Ganne-Carrié N;Séror O;Larrey E;Lim C;Scatton O;El Mouhadi S;Ozenne V;Paye F;Balladur P;Dohan A;Massault PP;Pol S;Dioguardi Burgio M;Vilgrain V;Sepulveda A;Cauchy F;Luciani A;Sommacale D;Leroy V;Roudot-Thoraval F;Bouattour M;Nault JC;Paris Liver Cancer Group
受肝细胞癌（HCC）影响的患者是COVID-19大流行期间的弱势群体，可能会受到医疗资源分配改变的影响。本研究旨在确定COVID-19大流行对法国巴黎大都市区6个转诊中心内HCC患者管理的影响。我们对COVID-19大流行前6周（暴露组）与2019年同期（未暴露组）的肝细胞癌患者管理进行了一项多中心、回顾性、横断面研究。我们纳入了在多学科肿瘤委员会（MTB）会议上讨论的所有患者和/或在研究期间接受放射学或手术程序的患者，目的是治愈或姑息治疗。终点是治疗策略改变或治疗决定延迟的患者数量。筛选后，纳入n = 670例患者（n = 293例暴露于COVID，n = 377例未暴露于COVID）。2020年，MTB就诊的HCC患者较少（p = 0.034），首次诊断为HCC的患者较少（n = 104暴露于COVID，n = 143未暴露于COVID，p = 0.083）。13.1%的患者修改了治疗策略，两个阶段之间无差异。然而，与2019年相比，2020年有21.5%的患者与9.5%的患者出现超过1个月的治疗延迟（p <0.001）。于二零二零年，7. 1%（21/293）的患者被诊断为活动性COVID-19感染：11名（52. 4%）患者住院，4名（19. 1%）患者死亡。在受COVID-19大流行高度影响的大都市地区，我们观察到HCC患者减少，治疗调整率相似，但2020年的治疗延迟时间明显长于2019年。在2019冠状病毒病（COVID-19）大流行时期，向多学科肿瘤委员会提交的肝细胞癌（HCC）患者较少，尤其是首次诊断为HCC的患者。HCC患者在COVID-19期间的治疗延迟时间长于2019年。在COVID-19期间，向多学科肿瘤委员会提交报告的HCC患者减少。在全球范围内，在13.1%的患者中观察到治疗策略的调整。超过21%的患者在COVID-19期间经历了>1个月的治疗延迟，而2019年为9. 5%。新型冠状病毒感染是2020年治疗延误的主要原因。于二零二零年，7. 1%的患者被诊断为活动性COVID-19感染，4/21（19. 1%）死亡。
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. 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. 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. 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. 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. During the COVID-19 period, fewer patients with HCC presented to the multidisciplinary tumour board. Globally, modification in the treatment strategy was observed in 13.1% of patients. More than 21% of patients experienced a treatment delay >1 month in the COVID-19 period compared with 9.5% in 2019. COVID-19 infection was the main reason for treatment delays in 2020. In 2020, 7.1% of patients had a diagnosis of an active COVID-19 infection and 4/21 (19.1%) died.
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