P0689 - Hepatocellular Carcinoma Screening in Patients with Substance Abuse Disorder in a Large Urban Safety Net Hospital

Josue Davila, MD, Sherif Saleh, MD, Neethi Paranji, MD, Bolin Niu, MD
MetroHealth Medical Center, Cleveland, OH

Introduction: Patients with substance abuse disorders are at an increased risk of viral hepatitis and alcohol-related liver disease and, consequently, are at increased risk of developing hepatocellular carcinoma (HCC). HCC is one of the leading causes of cancer-related deaths in the United States. It is unclear if screening for HCC differs in cirrhotic patients with substance abuse and those without. We performed a retrospective study to evaluate the association of substance abuse disorders with HCC screening and outcomes.

Methods: A manual chart review was performed for all patients diagnosed with HCC at a large urban safety-net hospital from 2010-2019. Statistical analyses were performed using Statistical Product and Service Solutions version 26.0 (SPSS, Inc., Chicago, Illinois). Qualitative and quantitative differences between groups were analyzed by Chi-square or Fisher’s exact tests for categorical variables and t-test for continuous variables.

Results: A total of 393 patients with HCC were included in the final analysis. Among them, 267 (68%) had a history of substance abuse. HCC patients with substance use were significantly more likely to be African-American and more likely to be diagnosed at a younger age (mean age 60 vs. 64). There was no difference in screening interval, defined as the time from the previous imaging study before the diagnosis of HCC, among HCC patients with or without a history of substance abuse. Interestingly, patients with substance abuse were more likely to have been seen by a gastroenterologist or hepatologist before the diagnosis of HCC (p = 0.006). Moreover, the palliative and curative treatment rates were similar between the two groups (p = 0.52).

Discussion: Our results suggest no significant differences in the etiology of liver diseases, HCC screening interval, MELD at diagnosis of HCC, and treatment recommendation at tumor board for those with and without substance abuse. This study highlights that despite the increased risk of liver diseases in patients with substance abuse disorders, they may not require more aggressive HCC screening than the general cirrhotic population. Finally, our data suggest that those with substance abuse were more likely to be diagnosed with HCC at a younger age; and, therefore, may benefit from specialist care and adequate screening.



Disclosures:


Josue Davila, MD, Sherif Saleh, MD, Neethi Paranji, MD, Bolin Niu, MD. P0689 - Hepatocellular Carcinoma Screening in Patients with Substance Abuse Disorder in a Large Urban Safety Net Hospital, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.