P56 A retrospective review of potential missed opportunities for earlier diagnosis of liver cirrhosis in patients with hepatocellular carcinoma (HCC)

<h3></h3> Hepatocellular carcinoma (HCC) is a primary liver cancer and is more common amongst patients with chronic liver disease (CLD). CLD is increasingly prevalent. Earlier identification would help identify patients who may benefit from HCC surveillance. This QIP was undertaken to assess whether missed opportunities for an earlier diagnosis of CLD was present amongst patients diagnosed with HCC, referred to a tertiary HCC centre. Patients with Newcastle HPB MDM confirmed HCC over a 1 year period were identified. Their sex, age, prior diagnosis of liver disease, route to HCC diagnosis (non-surveillance, surveillance) and features of liver cirrhosis present on imaging were recorded. Additionally, for patients presenting through non-surveillance routes, any imaging or blood tests taken in the past 5 years were noted. Information was obtained from MDT referral letter, MDT outcome sheet, tertiary HCC clinic letter, and the North East regional ICE OpenNET system. A total of 152 cases from March 2022 to February 2023 were reviewed. 98 patients presented through non-surveillance route. Of these, 20 patients had a prior diagnosis of cirrhosis while 78 did not. Of the 78 with no prior diagnosis of cirrhosis, 36 (46.2%) had suspected or confirmed features of cirrhosis on imaging. Amongst these 36 patients, 18 had either prior abnormal LFTs or imaging suggestive of CLD, or a combination of both. In these 18 patients, 6 were staged HCC BCLC-A, with 2 BCLC-B, 9 BCLC-C and 1 BCLC-D. Of the 20 patients with known cirrhosis presenting through non-surveillance routes, 7 had been in appropriate surveillance, 2 had declined surveillance, 4 were diagnosed with cirrhosis less than a year prior to HCC diagnosis, and in 7 it was unclear if surveillance had been considered. The median age range of patients in the subgroups (figure 1) were similar (72–73) but those with suspected or confirmed cirrhosis on imaging had younger patients. This review identifies that almost half of patients diagnosed with HCC with no prior diagnosis of CLD, had a concurrent radiological diagnosis of cirrhosis. Furthermore, half of these had potential missed opportunities for earlier diagnosis of CLD. It has to be remembered that age and co-morbidities are important considerations for surveillance, emphasising that earlier detection of liver disease is imperative for timely enrolment of suitable patients into surveillance pathways. Overall, this review highlights the prevalence of abnormal liver function and imaging, with missed opportunities for secondary care referral and consideration of HCC surveillance.