A0490 - Association Between Distance to a Radiology Center and HCC Surveillance Among Patients With Cirrhosis in Florida

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Adam Burton, BS

University of Miami Miller School of Medicine
Miami, FL

Adam Burton, BS¹, Darius Chyou, MD², David S. Goldberg, MD, MSCE¹
¹University of Miami Miller School of Medicine, Miami, FL; ²University of Miami/Jackson Memorial Hospital, Miami, FL

Introduction: Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality in patients with cirrhosis, and HCC survival is directly correlated with stage at diagnosis. Current guidelines recommend HCC surveillance with an abdominal ultrasound every 6 months, but unfortunately many patients do not meet this threshold.¹ Our aim was to determine whether distance to a radiology center, measured in travel time, was associated with HCC surveillance rates.

Methods: We included data on adult patients with cirrhosis within the OneFlorida Clinical Research Consortium from October 1, 2015- December 31, 2019. The primary outcome was a continuous measure of the percentage of time up to date with HCC surveillance (PTUDS) based on abdominal ultrasound (US), triple phase CT, and/or MRI with contrast. Travel time was calculated using ArcGIS geomodelling software as the estimated minimum travel time between the geographic centroid of patient’s zip code and the nearest American College of Radiology-accredited center for US, CT, and/or MRI. Linear regression models were fit with PTUDS as the outcome; all covariates with a p< 0.05 were included in the final multivariable model.

Results: Among 25,299 patients with cirrhosis (median follow-up=4.1 years), the median PTUDS was 10.0% (interquartile range 0-29.9%). Variables found to have a statistically significant association with PTUDS are displayed in Table 1. Travel time, hepatic encephalopathy at baseline, and ascites at baseline were associated with increased PTUDS. Patients with alcohol-related liver disease, nonalcoholic steatohepatitis, and cryptogenic cirrhosis had lower PTUDS compared with patients with HCV.

Discussion: Travel time to the nearest radiology center is not associated with lower HCC surveillance rates while race, etiology of liver disease, and disease severity do appear to variably influence surveillance. By establishing factors associated with currently suboptimal surveillance rates, we can create targeted interventions to improve surveillance and, ultimately, patient outcomes.

1. Yang JD, Mannalithara A, Piscitello AJ, et al. Impact of surveillance for hepatocellular carcinoma on survival in patients with compensated cirrhosis. Hepatology. 2018;68(1):78-88.

Figure: Figure 1: Median PTUDS by County

Variable	Beta Coefficient, 95% CI	P-Value
Travel Time	0.0016 (0.0012-0.0020)	< 0.001
Liver Disease Etiology
Hepatitis C Virus	Reference	-
Hepatitis B Virus	0.0246 (0.0019-0.0473)	0.034
Wilson's Disease	0.0137 (-0.571-0.0845)	0.704
Hemochromatosis	0.0067 (-0.0220-0.0354)	0.647
a1-Antitrypsin Deficiency	0.0673 (0.0200-0.1145)	0.005
Alcohol-Related Liver Disease	-0.0720 (-0.0801- -0.0639)	< 0.001
Primary Biliary Cholangitis	-0.0037 (-0.0261- 0.0186)	0.745
Autoimmune Hepatitis	-0.0193 (-0.0406- 0.0019)	0.075
Primary Sclerosing Cholangitis	0.0123 (-0.0462- 0.0708)	0.680
Nonalcoholic Steatohepatitis	-0.0835 (-0.0917- -0.0752)	< 0.001
Unknown/Cryptogenic	-0.01566 (-0.1664- -0.1467)	< 0.001
Race
White/Caucasian	Reference	-
American Indian/Alaskan	-0.0207 (-0.0871- 0.0457)	0.541
Asian	0.0531 (0.0258- 0.0805)	< 0.001
Black	0.0171 (0.0082- 0.0260)	< 0.001
Native Hawaiian/Pacific Islander	-0.0075 (-0.1109- 0.0959)	0.887
Multiple Race	-0.0474 (-0.0781- -0.0168)	0.002
Refuse to answer	0.0904 (0.0212- 0.1596)	0.010
No information	0.0575 (0.0283- 0.0866)	< 0.001
Other	0.0050 (-0.0048- 0.0148)	0.318
Unknown	-0.0591 (-0.0837- -0.0346)	< 0.001
Disease Severity
Hepatic Encephalopathy at Baseline	0.0431 (0.0328- 0.0534)	< 0.001
Ascites at Baseline	0.0638 (0.0551- 0.0724)	< 0.001

Table: Table 1: Multivariable Linear Regression Model of Factors Associated with HCC Surveillance

Disclosures:

Adam Burton indicated no relevant financial relationships.

Darius Chyou indicated no relevant financial relationships.

David Goldberg indicated no relevant financial relationships.

Adam Burton, BS¹, Darius Chyou, MD², David S. Goldberg, MD, MSCE¹. A0490 - Association Between Distance to a Radiology Center and HCC Surveillance Among Patients With Cirrhosis in Florida, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.