Impact of COVID-19 on the management of hepatocellular carcinoma in a high-prevalence area

Amaddeo, Giuliana; Brustia, Raffaele; Allaire, Manon; Lequoy, Marie; Hollande, Clémence; Regnault, Hélène; BLAISE, Lorraine; Ganne-carrié, Nathalie; Séror, Olivier; Larrey, Edouard; Lim, Chetana; Scatton, Olivier; El mouhadi, Sanaa; Ozenne, Violaine; Paye, François; Balladur, Pierre; Dohan, Anthony; Massault, Pierre-Philippe; Pol, Stanislas; Dioguardi burgio, Marco; Vilgrain, Valérie; Sepulveda, Ailton; Cauchy, Francois; Luciani, Alain; Sommacale, Daniele; Leroy, Vincent; Roudot-thoraval, Francoise; Bouattour, Mohamed; Nault, Jean-Charles

BACKGROUND: Patients affected by HCC represent a vulnerable population during the COVID-19 pandemic and may suffer from the unusual allocation of healthcare resources. The aim of this study was to determine the impact of the COVID-19 pandemic on the management of HCC patients within six French referral centers of the metropolitan area of Paris. MATERIALS AND METHODS: We performed a multicenter, retrospective, cross-sectional study on the management of patients affected by HCC during the first six weeks of COVID-19 pandemic (exposed), compared to the same period in 2019 (unexposed). Were included all patients discussed in multidisciplinary tumor meeting (MTB) and/or undergoing radiological or surgical programmed procedure during the study period, in a curative or palliative intent. Endpoints were the number of patients with a modification in the treatment strategy, or a delay in decision-to-treatment. RESULTS: After screening, n=670 patients were included (n=293 Exposed to COVID, n=377 Unexposed to COVID). A decrease of the numbers of patients with HCC presented in MTB in 2020 (p=0.034) and with a first diagnosis of HCC (n=104 Exposed to COVID, n=143 Unexposed to COVID, p=0.083) was find. Modification in the treatment strategy was observed in 13.1% of patients, with no differences between the two periods. Nevertheless 21.5% versus 9.5% of patients experienced a treatment delay longer than 1 month in 2020 compared to 2019 (p<0.001). In 2020, 7.1% (21/293) of patients had a diagnosis of an active COVID-19 infection: 11 (52.4%) were hospitalized, and 4 (19.1%) died. CONCLUSIONS: In a metropolitan area highly impacted by COVID-19 pandemic, we observed a decreased number of cases of HCC, and similar rates of modification in treatment strategy, but with a treatment delay significantly longer in 2020 versus 2019.