Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area
Giuliana Amaddeo,
Raffaele Brustia,
Manon Allaire,
Marie Lequoy,
Clémence Hollande,
Hélène Regnault,
Lorraine Blaise,
Nathalie Ganne-Carrié,
Olivier Séror,
Edouard Larrey,
Chetana Lim,
Olivier Scatton,
Sanaa El Mouhadi,
Violaine Ozenne,
François Paye,
Pierre Balladur,
Anthony Dohan,
Pierre-Philippe Massault,
Stanislas Pol,
Marco Dioguardi Burgio,
Valérie Vilgrain,
Ailton Sepulveda,
Francois Cauchy,
Alain Luciani,
Daniele Sommacale,
Vincent Leroy,
Francoise Roudot-Thoraval,
Mohamed Bouattour,
Jean-Charles Nault
Affiliations
Giuliana Amaddeo
Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France; Paris Est Créteil University, UPEC, Créteil, France; INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France; Corresponding authors. Addresses: Hepatology Department, Hôpitaux Universitaires Henri-Mondor, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil Cedex, France. Tel.: +33 649875673; fax: +3149812352.
Raffaele Brustia
Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
Manon Allaire
Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France; Sorbonne Université, Paris, France
Marie Lequoy
Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
Clémence Hollande
Department of Hepatology, AP-HP, Hôpital Cochin, Paris, France
Hélène Regnault
Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
Lorraine Blaise
Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France
Nathalie Ganne-Carrié
Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France
Olivier Séror
Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France; Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France; INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
Edouard Larrey
Hepatology and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France; Sorbonne Université, Paris, France
Chetana Lim
Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
Olivier Scatton
Sorbonne Université, Paris, France; Digestive and Liver Transplantation Department, Hôpital Pitié Salpêtrière, Sorbonne Université, AP-HP, Paris, France
Sanaa El Mouhadi
Department of Radiology, AP-HP, Hôpital Saint Antoine, Paris, France
Violaine Ozenne
Department of Hepatology, AP-HP, Hôpital Saint Antoine, Paris, France
François Paye
Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
Pierre Balladur
Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France
Anthony Dohan
Department of Radiology, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
Pierre-Philippe Massault
Department of Digestive Surgery, AP-HP, Hôpital Cochin, Université de Paris, Paris, France
Stanislas Pol
Department of Hepatology, AP-HP, Hôpital Cochin, Paris, France
Marco Dioguardi Burgio
Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France; INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
Valérie Vilgrain
Department of Radiology, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France; INSERM U1149 “Centre de Recherche sur l'Inflammation”, CRI, Paris, France
Ailton Sepulveda
Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
Francois Cauchy
Digestive and Liver Transplantation Department, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance-Publique Hôpitaux de Paris, Clichy, France
Alain Luciani
Paris Est Créteil University, UPEC, Créteil, France; Department of Radiology, AP-HP, Hôpital Henri-Mondor, Créteil, France
Daniele Sommacale
Paris Est Créteil University, UPEC, Créteil, France; INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France; Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Créteil, France
Vincent Leroy
Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France; Paris Est Créteil University, UPEC, Créteil, France; INSERM U955, Team “Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers”, Assistance Publique-Hôpitaux de Paris, Créteil, France
Francoise Roudot-Thoraval
Department of Hepatology, AP-HP, Hôpital Henri-Mondor, Créteil, France
Mohamed Bouattour
Département d'Oncologie Digestive, AP-HP, Hôpital Beaujon, Clichy, France
Jean-Charles Nault
Service d'Hépatologie, Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bondy, France; Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université Paris, INSERM UMR 1138 Functional Genomics of Solid Tumors Laboratory, Paris, France; Hepatology Department, Hôpital Jean Verdier, Avenue du 14 juillet, 93140 Bondy, France. Tel.: +33 6 10 67 94 61; fax: +33 1 53 72 51 92.
Background & Aims: 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. Methods: 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. Results: 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. Conclusions: 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. Lay summary: 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.
