HEPATOCELLULAR CARCINOMA (HCC) OUTCOMES IN A PUBLIC HOSPITAL SETTING WITH INCREASED ACCESSIBILITY TO PROCEDURAL BASED THERAPY T. Joshi MD, J. DiTrapani MS3, E. Ellent MD, B. Boulmay MD Department of Internal Medicine, LSU Health Sciences Center, New Orleans, LA INTRODUCTION: HCC is a significant burden on our healthcare system. In the United States, this cancer has risen from 1.4 to 6.7 per 100,000 people over the past two decades. Hepatitis C virus (HCV) is the most common cause of HCC; 25% of patients (pts) with HIV are coinfected with HCV. HCC has a 5-year survival rate below 12%; identifying those at risk may improve outcomes. The uninsured/indigent populations may face poorer outcomes with increased morbidity and mortality. METHODS/RESULTS: A retrospective chart review was conducted to analyze a cohort of 124 patients diagnosed with HCC from 2013 to 2018 at University Medical Center in New Orleans (UMCNO). Descriptive characteristics of patients in the study include ethnicity, sex, hepatitis B (HBV) and HCV status, HCC screening, alcohol, location of metastasis, AFP at time of diagnosis. One-year survival rates as well as current dead or alive status were also obtained. Using logistic regression, outcomes of a previous study analyzing a similar population (n=107) from (2007-2013) were comparatively analyzed. The significance of survival differences between those under HCC screening protocol as well as presentations with AFP>1000 was approximated using the Kaplan–Meier method (see graph). RESULTS: Demographic analysis of those diagnosed with HCC revealed 84% were male and 16% were female. With a mean age of 59.07; 44% were African American, 33% were Caucasian, 7% were Asian, 2% Hispanic and 13% unknown ethnicity. 83% of pts had HCV, 7% had HBV, 3% had HCV /HBV and 7% had HIV/HCV. Of those who had a hepatitis viral infection, 34% were screened for HCC. 52.23%of patients abused alcohol. The most common site of metastasis was the lung 16.13% (n=20) with the second being bone 7.26% (n=9). The overall survival rate of 1 year was calculated with the one year survival rate being significantly increased when compared to the previous study (29% to 62%). CONCLUSION: Significant findings were present in this patient population. Both HCC screening and AFP levels were found to be statistically correlated to overall survival at three years. These data would be in line with some studies recommending AFP testing pre- treatment as a method to modify HCC staging systems. We compared our findings to a statistical analysis completed of a similar population between 2007-2013 at UMCNO. There was an increase in the number of Caucasians (24% to 33%) as well as patients infected with HCV (75% to 85%). Usage of HCC screening increased from 15% to 36%.The increased survival between cohorts is potentially a consequence of the increased utilization of HCC screening.
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