P38 BASL 2024 – an audit of hepatocellular carcinoma surveillance at bradford royal infirmary

<h3>Background</h3> Hepatocellular carcinoma (HCC) has a rising incidence and mortality in the UK. Improved survival is best affected by early diagnosis. HCC surveillance is costly, and its effectiveness and format is debated. This audit aimed to evaluate the outcomes of HCC surveillance at our hospital <h3>Method</h3> A single centre audit of hepatocellular carcinomas diagnosed between 2013 and May 2023 from MDT data. Initial dataset of 158 patients. Data from 38 cases were not available. A further 31 cases were excluded due to significant irresolvable data gaps. In total, 70 cases were included. Statistical analyses with Chi-Square test with statistical significance set at p&lt;0.05. <h3>Results</h3> There were 70 HCC patients, of whom 56 were male (80%, mean age 71.1 years, age range 49.03–90.76) and 14 were female (20%, mean age 69.72, age range 48.12–88.00). The underlying liver disease was: Undiagnosed or no liver disease (25.7%, n=18), Hepatitis C (HCV, 24.3%, n=17), Alcohol-related liver disease (ARLD, 21.4%, n=15), Metabolic dysfunction-associated steatotic liver disease (MASLD, 17.1%, n=12), Hepatitis B (HBV, 5.71%, n=4), Primary biliary cirrhosis (PBC, 2.86%, n=2), Haemochromatosis (1.43%, n=1), and Cardiac cirrhosis (1.43%, n=1). HCC patients enrolled in surveillance were significantly more likely to have a lower radiological staging grade at diagnosis than HCC patients not enrolled. 89.5% of the surveillance cohort (n=17) were T1a/T1b/T2 at diagnosis, compared to 45.1% of the non-surveillance cohort (n=23), p=0.000849. Our patients diagnosed with HCC whilst in surveillance were also significantly more likely to receive potentially curative treatments (resection, ablation and transplant) than patients not enrolled in surveillance (52.6% vs 15.7%, p=0.00166). Further, HCC patients enrolled in surveillance had a significantly greater rate of survival at 9, 12 and 24 months (9-month survival: 78.9% vs 52.9%, p=0.0482, 12-month survival: 73.9% vs 46.8%, p=0.0471, 24-month survival: 64.7% vs 35.9%, p=0.0462). There was significantly more HCV-related HCC detected in the surveillance population than the non-surveillance population. HCV represented 42.1% of surveillance detected HCC (n=8), versus 13.7% (n=7) of the non-surveillance cohort, p=0.0101), highlighting the success of HCV management at BRI. <h3>Conclusion</h3> HCC patients enrolled in surveillance were significantly more likely to have an earlier stage of disease at diagnosis, significantly more likely to receive potentially curative treatment, and significantly more likely to be alive at 9-, 12- and 24-months, than HCC patients not enrolled in surveillance. Most HCC were diagnosed outside of surveillance, with a 27.1% surveillance-detection rate, as compared to national average of 25.8%.