Diagnostic delays are common among patients with hepatocellular carcinoma

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Abstract

Background: Most patients with hepatocellular carcinoma (HCC) present at advanced stages. The prevalence and clinical impact of delays during diagnostic evaluation among patients with HCC is unclear. Purpose: To identify and characterize factors associated with diagnostic delays among patients with HCC. Methods: Records were reviewed for consecutive patients with cirrhosis and HCC at a large urban hospital between January 2005 and July 2012. Time from presentation to diagnosis was determined using Kaplan-Meier analysis. Diagnostic delay was defined as time to diagnosis exceeding 3 months, and multivariate logistic regression was used to identify correlates of diagnostic delays. Results: Among 457 patients with HCC, 226 (49.5%) were diagnosed as outpatients. Among these, median time-to-diagnosis was 2.2 months, with 87 patients (38.5%) experiencing a diagnostic delay. Diagnostic delays were positively associated with the presence of hepatic encephalopathy (odds ratio [OR], 2.29; 95% CI, 1.03-5.07) and negatively associated with presentation after implementation of the electronic medical records (EMR) (OR, 0.28; 95% CI, 0.15-0.52) and presentation with an abnormal ultrasound (OR, 0.36; 95% CI, 0.19-0.67) on multivariate analysis. Higher rates of diagnostic delays were observed among those with hepatic encephalopathy (56% vs 35%), whereas lower rates were seen in those who presented after EMR implementation (26% vs 60%) and those who presented with an abnormal ultrasound with or without an elevated alpha fetoprotein level (27% vs 50%). Among 49 patients with mass-forming HCC and diagnostic delay, 18% had interval tumor growth of 2 cm or greater. Conclusions: Nearly 20% of patients with HCC wait more than 3 months from presentation to diagnosis, which can contribute to interval tumor growth.

Original languageEnglish (US)
Pages (from-to)543-549
Number of pages7
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume13
Issue number5
StatePublished - May 1 2015

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Hepatocellular Carcinoma
Hepatic Encephalopathy
Electronic Health Records
Odds Ratio
Urban Hospitals
Kaplan-Meier Estimate
alpha-Fetoproteins
Growth
Neoplasms
Fibrosis
Outpatients
Multivariate Analysis
Logistic Models

ASJC Scopus subject areas

  • Oncology

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Diagnostic delays are common among patients with hepatocellular carcinoma. / Patel, Nishant; Yopp, Adam C.; Singal, Amit G.

In: JNCCN Journal of the National Comprehensive Cancer Network, Vol. 13, No. 5, 01.05.2015, p. 543-549.

Research output: Contribution to journalArticle

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